Active NPI
Kelly Diem Thi Pham, PHARMD
- Pharmacist
- Riverside, CA
National Provider Identifier
1386354371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 87065
- Practice address
- 6840 Lincoln Ave
Riverside, CA 92506-4256 - Phone
- (951) 369-9941
- NPI assigned
- Nov 30, 2022
- Last updated
- Nov 30, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 | 87065 | CA | Primary |
Addresses
Primary practice location
6840 Lincoln Ave
Riverside, CA 92506-4256
Mailing address
11481 Dorset Dr
Riverside, CA 92503-5129
Phone (951) 742-3343
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garfield Beach CVS LLC | Past | Accepting new patients | |
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669766400000",
"number": "1386354371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11481 DORSET DR",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925035129",
"telephone_number": "951-742-3343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6840 LINCOLN AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925064256",
"telephone_number": "951-369-9941"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "KELLY",
"middle_name": "DIEM THI",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-30",
"last_updated": "2022-11-30",
"certification_date": "2022-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "87065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.