Provider Demographics
NPI:1164028262
Name:TRAN, THU- AN THI
Entity Type:Individual
Prefix:MRS
First Name:THU- AN
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:THU-AN
Other - Middle Name:THI
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-3419
Mailing Address - Country:US
Mailing Address - Phone:972-288-4485
Mailing Address - Fax:
Practice Address - Street 1:500 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3419
Practice Address - Country:US
Practice Address - Phone:972-288-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist