Provider Demographics
NPI:1043816937
Name:TRAN, TAN DUY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:DUY
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15180 KENSINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1801
Mailing Address - Country:US
Mailing Address - Phone:714-259-7625
Mailing Address - Fax:
Practice Address - Street 1:15180 KENSINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1801
Practice Address - Country:US
Practice Address - Phone:714-259-7625
Practice Address - Fax:714-259-4849
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist