Provider Demographics
NPI:1275993214
Name:TRAN, LONG HOANG
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:HOANG
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11428 S EASTERLYN CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-5204
Mailing Address - Country:US
Mailing Address - Phone:504-756-8826
Mailing Address - Fax:
Practice Address - Street 1:2240 SIMON BOLIVAR AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1480
Practice Address - Country:US
Practice Address - Phone:504-267-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist