Provider Demographics
NPI:1962770479
Name:PHAM, CAROLYN THUY SEN (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:THUY SEN
Last Name:PHAM
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93423-0663
Mailing Address - Country:US
Mailing Address - Phone:714-383-7280
Mailing Address - Fax:
Practice Address - Street 1:8005 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5211
Practice Address - Country:US
Practice Address - Phone:714-383-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 66550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist