Provider Demographics
NPI:1225774474
Name:PHAM, CHRISTINE DA-THAO (RPH)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:DA-THAO
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 1:203 PHARMACY BLDG
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97331-8537
Mailing Address - Country:US
Mailing Address - Phone:541-737-3424
Mailing Address - Fax:
Practice Address - Street 1:12555 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5683
Practice Address - Country:US
Practice Address - Phone:503-495-4157
Practice Address - Fax:971-266-2950
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61602902183500000X
ORPI-0013899390200000X
ORRPH-0020192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program