Provider Demographics
NPI:1538574652
Name:PHAM, JESSICA (PHARM D)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 W WETHERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1902
Mailing Address - Country:US
Mailing Address - Phone:602-942-4764
Mailing Address - Fax:602-942-4839
Practice Address - Street 1:1825 W BELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3418
Practice Address - Country:US
Practice Address - Phone:602-942-4764
Practice Address - Fax:602-942-4839
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016841183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist