Provider Demographics
NPI:1275940165
Name:VAN, TRANG
Entity Type:Individual
Prefix:MRS
First Name:TRANG
Middle Name:
Last Name:VAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TRANG
Other - Middle Name:
Other - Last Name:VAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:10222 W 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1836
Mailing Address - Country:US
Mailing Address - Phone:316-729-1535
Mailing Address - Fax:
Practice Address - Street 1:10222 W 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1836
Practice Address - Country:US
Practice Address - Phone:316-729-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-13
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist