Provider Demographics
NPI:1225679566
Name:TRAN, MICHELLE NGOC ANH
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:NGOC ANH
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7417 ETUDE DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-5992
Mailing Address - Country:US
Mailing Address - Phone:504-390-0432
Mailing Address - Fax:
Practice Address - Street 1:4945 LAPALCO BLVD STE 206
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4313
Practice Address - Country:US
Practice Address - Phone:504-638-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist