Provider Demographics
NPI:1902174402
Name:PHAM, ANH THU NU (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANH
Middle Name:THU NU
Last Name:PHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11859 TRAIL CREST DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-6147
Mailing Address - Country:US
Mailing Address - Phone:858-271-5404
Mailing Address - Fax:858-997-2426
Practice Address - Street 1:7345 LINDA VISTA RD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5800
Practice Address - Country:US
Practice Address - Phone:858-256-9248
Practice Address - Fax:858-997-2426
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH52983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist