Provider Demographics
NPI:1457179053
Name:PHAM, THU QUYNH ANH (PHARMD)
Entity type:Individual
Prefix:
First Name:THU
Middle Name:QUYNH ANH
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 E HERMOSA LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-0605
Mailing Address - Country:US
Mailing Address - Phone:714-757-3323
Mailing Address - Fax:
Practice Address - Street 1:690 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3957
Practice Address - Country:US
Practice Address - Phone:909-608-7419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist