Provider Demographics
NPI:1104324755
Name:PHAM, VICTORIA ANHTHU (PHARMD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANHTHU
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VINE ST UNIT 606
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-5107
Mailing Address - Country:US
Mailing Address - Phone:916-333-9357
Mailing Address - Fax:
Practice Address - Street 1:566 DENNY WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5012
Practice Address - Country:US
Practice Address - Phone:206-204-1982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60767127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist