Provider Demographics
NPI:1053628370
Name:TRAN, STACY NGOC THUC (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:NGOC THUC
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 1:4740 WIOTA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2428
Mailing Address - Country:US
Mailing Address - Phone:626-796-5539
Mailing Address - Fax:
Practice Address - Street 1:1038 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2323
Practice Address - Country:US
Practice Address - Phone:626-796-5539
Practice Address - Fax:626-796-6969
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist