Provider Demographics
NPI:1235411737
Name:TRANG, VIVIAN (RPH)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:TRANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 COUNTRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1818
Mailing Address - Country:US
Mailing Address - Phone:571-274-5964
Mailing Address - Fax:
Practice Address - Street 1:3526 COUNTRY HILL DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1818
Practice Address - Country:US
Practice Address - Phone:571-274-5964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210510183500000X
FLPS47107183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist