Provider Demographics
NPI:1720719560
Name:PHAM, QUYNH X (PHARMD)
Entity type:Individual
Prefix:
First Name:QUYNH
Middle Name:X
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 1:1811 PEBBLE COVE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4904
Mailing Address - Country:US
Mailing Address - Phone:702-762-2455
Mailing Address - Fax:702-451-1808
Practice Address - Street 1:3850 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6299
Practice Address - Country:US
Practice Address - Phone:702-451-5536
Practice Address - Fax:702-451-1808
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69597183500000X
NV18111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist