Provider Demographics
NPI:1053472456
Name:PHAM, THAI (RPH)
Entity type:Individual
Prefix:
First Name:THAI
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6137 GLENWORTH CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8559
Mailing Address - Country:US
Mailing Address - Phone:614-206-9879
Mailing Address - Fax:614-358-6500
Practice Address - Street 1:5690 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8127
Practice Address - Country:US
Practice Address - Phone:614-870-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-20917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist