Provider Demographics
NPI:1003192394
Name:TRAN, TRACEY T (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:T
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14550 ONTARIO DR
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5678
Mailing Address - Country:US
Mailing Address - Phone:714-388-5441
Mailing Address - Fax:
Practice Address - Street 1:14550 ONTARIO DR
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5678
Practice Address - Country:US
Practice Address - Phone:714-388-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist