Provider Demographics
NPI:1326340787
Name:TRAN, PHONG (PHARM D)
Entity Type:Individual
Prefix:
First Name:PHONG
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WHITESELL ST NW
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-9329
Mailing Address - Country:US
Mailing Address - Phone:360-893-0843
Mailing Address - Fax:360-893-0856
Practice Address - Street 1:215 WHITESELL ST NW
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-9329
Practice Address - Country:US
Practice Address - Phone:360-893-0843
Practice Address - Fax:360-893-0856
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00068555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist