Provider Demographics
NPI:1124501275
Name:PHAM, LINH NGOC (RPH)
Entity type:Individual
Prefix:
First Name:LINH
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5149 HOLLY RIDGE FARM RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6105
Mailing Address - Country:US
Mailing Address - Phone:919-931-3619
Mailing Address - Fax:
Practice Address - Street 1:2512 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7249
Practice Address - Country:US
Practice Address - Phone:919-516-5718
Practice Address - Fax:919-883-9703
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1583622OtherCVS EMPLOYEE ID