Provider Demographics
NPI:1073382727
Name:TRAN, PHILLIP QUANG
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:QUANG
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7664
Mailing Address - Country:US
Mailing Address - Phone:559-285-7874
Mailing Address - Fax:
Practice Address - Street 1:563 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-7664
Practice Address - Country:US
Practice Address - Phone:559-285-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist