Provider Demographics
NPI:1396144655
Name:PHAM, TUONG-VI VIVIAN
Entity type:Individual
Prefix:
First Name:TUONG-VI
Middle Name:VIVIAN
Last Name:PHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MANHATTAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3405
Mailing Address - Country:US
Mailing Address - Phone:504-366-3358
Mailing Address - Fax:
Practice Address - Street 1:1501 MANHATTAN BLVD
Practice Address - Street 2:PHARMACY
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3405
Practice Address - Country:US
Practice Address - Phone:504-366-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.020721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist