Provider Demographics
NPI:1316328891
Name:PHAM, TOAN
Entity type:Individual
Prefix:MR
First Name:TOAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E PIONEER PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5853
Mailing Address - Country:US
Mailing Address - Phone:817-583-6998
Mailing Address - Fax:817-586-0021
Practice Address - Street 1:1115 E PIONEER PKWY STE 103
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5853
Practice Address - Country:US
Practice Address - Phone:817-584-6657
Practice Address - Fax:817-583-6998
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist