Provider Demographics
NPI:1265032205
Name:TRAN, THUY THU THI
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:THU THI
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 1:11519 S NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-6417
Mailing Address - Country:US
Mailing Address - Phone:918-294-9700
Mailing Address - Fax:918-252-5577
Practice Address - Street 1:6625 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2036
Practice Address - Country:US
Practice Address - Phone:918-294-9700
Practice Address - Fax:918-252-5577
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist