Provider Demographics
NPI:1366521973
Name:PHAM, THUY THI (PHARMD)
Entity type:Individual
Prefix:
First Name:THUY
Middle Name:THI
Last Name:PHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 N WILMOT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5523
Mailing Address - Country:US
Mailing Address - Phone:773-292-1457
Mailing Address - Fax:
Practice Address - Street 1:833 SOUTH WOOD STREET, ROOM 164
Practice Address - Street 2:DEPARTMENT OF PHARMACY PRACTICE (MC 886)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7230
Practice Address - Country:US
Practice Address - Phone:312-996-0897
Practice Address - Fax:312-996-0379
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL512885361835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy