Provider Demographics
NPI:1548817109
Name:PHAM, THANH VU MINH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THANH
Middle Name:VU MINH
Last Name:PHAM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6255 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1403
Mailing Address - Country:US
Mailing Address - Phone:267-437-9621
Mailing Address - Fax:
Practice Address - Street 1:2131 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-1105
Practice Address - Country:US
Practice Address - Phone:215-236-2297
Practice Address - Fax:215-236-7216
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP453802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist