Provider Demographics
NPI:1336354273
Name:PHAM, VINH PHU (RPH)
Entity type:Individual
Prefix:
First Name:VINH
Middle Name:PHU
Last Name:PHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N STEPHANIE ST
Mailing Address - Street 2:SUITE D242
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8115
Mailing Address - Country:US
Mailing Address - Phone:858-243-4380
Mailing Address - Fax:928-697-4168
Practice Address - Street 1:HIGHWAY 163 KA 2010
Practice Address - Street 2:
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist