Active NPI
Cecilia Kimloan Pham
- Pharmacist
- Santa Rosa, CA
National Provider Identifier
1629423744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 75706
- Practice address
- 2300 Mendocino Ave
Santa Rosa, CA 95403-3115 - Phone
- (707) 569-3111
- NPI assigned
- Apr 26, 2016
- Sex
- Female
- 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 | 75706 | CA | Primary |
Addresses
Primary practice location
2300 Mendocino Ave
Santa Rosa, CA 95403-3115
Mailing address
2300 Mendocino Ave
Santa Rosa, CA 95403-3115
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75706 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | 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 and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Santa Rosa, CA
- NPI 1639115249
-
- Community/Retail Pharmacy
- Queen Creek, AZ
- NPI 1730040973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476316800000",
"number": "1629423744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 MENDOCINO AVE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954033115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 MENDOCINO AVE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954033115",
"telephone_number": "707-569-3111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "CECILIA",
"middle_name": "KIMLOAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-26",
"last_updated": "2016-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "75706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.