Provider Demographics
NPI:1598093023
Name:PHAM, MAI THI PHUONG (RPH)
Entity type:Individual
Prefix:MRS
First Name:MAI
Middle Name:THI PHUONG
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 1:12407 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2420
Mailing Address - Country:US
Mailing Address - Phone:281-655-0478
Mailing Address - Fax:281-655-0726
Practice Address - Street 1:12407 GRANT RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2420
Practice Address - Country:US
Practice Address - Phone:281-655-0478
Practice Address - Fax:281-655-0726
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist