Provider Demographics
NPI:1093354821
Name:TRAN, EMMA LAN THANH (RPH)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LAN THANH
Last Name:TRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:THI
Other - Middle Name:THANH LAN
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15923 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5435
Mailing Address - Country:US
Mailing Address - Phone:503-488-0681
Mailing Address - Fax:
Practice Address - Street 1:7901 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2314
Practice Address - Country:US
Practice Address - Phone:503-384-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0017233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist