Provider Demographics
NPI:1124624366
Name:PHAM, CHEN (RPH)
Entity type:Individual
Prefix:
First Name:CHEN
Middle Name:
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 1:703 GALLIVAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5423
Mailing Address - Country:US
Mailing Address - Phone:617-287-8292
Mailing Address - Fax:617-474-1901
Practice Address - Street 1:703 GALLIVAN BLVD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5423
Practice Address - Country:US
Practice Address - Phone:617-287-8292
Practice Address - Fax:617-474-1901
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAP24232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist