Provider Demographics
NPI:1083867303
Name:TRAN, CONG N (RPH)
Entity Type:Individual
Prefix:
First Name:CONG
Middle Name:N
Last Name:TRAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 S 120TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-4433
Mailing Address - Country:US
Mailing Address - Phone:206-371-7697
Mailing Address - Fax:
Practice Address - Street 1:9000 RAINIER AVE S STE C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5017
Practice Address - Country:US
Practice Address - Phone:206-760-1076
Practice Address - Fax:206-760-2655
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00071965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist