Provider Demographics
NPI:1093000200
Name:TRAN, THANH-VAN P (PHARMD)
Entity Type:Individual
Prefix:
First Name:THANH-VAN
Middle Name:P
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 1:20200 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7821
Mailing Address - Country:US
Mailing Address - Phone:562-274-0062
Mailing Address - Fax:562-274-0062
Practice Address - Street 1:20200 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7821
Practice Address - Country:US
Practice Address - Phone:562-274-0062
Practice Address - Fax:562-274-0062
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist