Provider Demographics
NPI:1164198834
Name:TRAN, TOAN THIEN (PHAMD)
Entity Type:Individual
Prefix:
First Name:TOAN
Middle Name:THIEN
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15110 PALADORA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1324
Mailing Address - Country:US
Mailing Address - Phone:714-725-4744
Mailing Address - Fax:
Practice Address - Street 1:16590 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-5895
Practice Address - Country:US
Practice Address - Phone:281-488-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist