Active NPI
Khoa Pham, PHARM. D.
- Pharmacist
- Winter Haven, FL
National Provider Identifier
1073858619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS49491
- Practice address
- 5545 Cypress Gardens Blvd
Winter Haven, FL 33884-2243 - Phone
- (863) 318-8686
- NPI assigned
- Dec 9, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS49491 | FL | Primary |
Addresses
Primary practice location
5545 Cypress Gardens Blvd
Winter Haven, FL 33884-2243
Mailing address
7036 Crooked Lake TRL
Orlando, FL 32818-8308
Phone (407) 437-5752
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS49491 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355011200000",
"number": "1073858619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7036 CROOKED LAKE TRL",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328188308",
"telephone_number": "407-437-5752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5545 CYPRESS GARDENS BLVD",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338842243",
"telephone_number": "863-318-8686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "KHOA",
"name_prefix": "Dr.",
"credential": "PHARM. D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-12-09",
"last_updated": "2012-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS49491",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.