Provider Demographics
NPI:1285042192
Name:TRAN, KRYSTIN
Entity Type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:
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 1:200 TECHNOLOGY CT SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 TECHNOLOGY CT SE
Practice Address - Street 2:SUITE B
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5250
Practice Address - Country:US
Practice Address - Phone:866-437-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0218521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist