Provider Demographics
NPI:1225310964
Name:TRAN, KIM T (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:T
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 1:2924 E 92ND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-4503
Mailing Address - Country:US
Mailing Address - Phone:773-721-6603
Mailing Address - Fax:773-721-2003
Practice Address - Street 1:2924 E 92ND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-4503
Practice Address - Country:US
Practice Address - Phone:773-721-6603
Practice Address - Fax:773-721-2003
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist