Provider Demographics
NPI:1114623501
Name:TRAN, THANH NGOC DANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:NGOC DANG
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 1:4909 N ELSINORE AVE APT N302
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6979
Mailing Address - Country:US
Mailing Address - Phone:541-740-2285
Mailing Address - Fax:
Practice Address - Street 1:6651 W FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0914
Practice Address - Country:US
Practice Address - Phone:208-489-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP10463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist