Active NPI
Mimi Lan Pham, PHARMD, MBA, MS
- Pharmacist
- Charlotte, NC
National Provider Identifier
1790519338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 29605
- Practice address
- 3440 Wilkinson Blvd
Charlotte, NC 28208-5634 - Phone
- (704) 395-3671
- NPI assigned
- Aug 27, 2024
- 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 | 29605 | NC | Primary |
Addresses
Primary practice location
3440 Wilkinson Blvd
Charlotte, NC 28208-5634
Mailing address
5209 Acadia Heights Dr Apt 2102
Charlotte, NC 28217-1707
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
- Master of Business Administration, Master of Science, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29605 | NC | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724716800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724716800000",
"number": "1790519338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5209 ACADIA HEIGHTS DR APT 2102",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282171707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3440 WILKINSON BLVD",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282085634",
"telephone_number": "704-395-3671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "MIMI",
"middle_name": "LAN",
"name_prefix": "Dr.",
"credential": "PHARMD, MBA, MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-27",
"last_updated": "2024-08-27",
"certification_date": "2024-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "29605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.