Provider Demographics
NPI:1487273553
Name:PHAM-CAO, JENNA P (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:P
Last Name:PHAM-CAO
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 1:10125 ANDRE DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5933
Mailing Address - Country:US
Mailing Address - Phone:713-679-9261
Mailing Address - Fax:
Practice Address - Street 1:10125 ANDRE DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5933
Practice Address - Country:US
Practice Address - Phone:713-679-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist