Provider Demographics
NPI:1073863734
Name:TRAN, TUAN-THANH (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:TUAN-THANH
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5159
Mailing Address - Country:US
Mailing Address - Phone:602-678-0594
Mailing Address - Fax:602-906-9304
Practice Address - Street 1:8035 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5159
Practice Address - Country:US
Practice Address - Phone:602-678-0594
Practice Address - Fax:602-906-9304
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist