Provider Demographics
NPI:1073999496
Name:TRAN, JULLIANE ROSE
Entity Type:Individual
Prefix:
First Name:JULLIANE
Middle Name:ROSE
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 S ROBB ST.
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:TX
Mailing Address - Zip Code:75862
Mailing Address - Country:US
Mailing Address - Phone:365-943-5939
Mailing Address - Fax:936-594-9681
Practice Address - Street 1:7423 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3221
Practice Address - Country:US
Practice Address - Phone:210-821-6992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist