Provider Demographics
NPI:1336317544
Name:TRAN, DAT THANH (BS PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:DAT
Middle Name:THANH
Last Name:TRAN
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 FALLSTON RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1415
Mailing Address - Country:US
Mailing Address - Phone:443-455-0410
Mailing Address - Fax:
Practice Address - Street 1:2401 CLEANLEIGH DR
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-6808
Practice Address - Country:US
Practice Address - Phone:410-668-0980
Practice Address - Fax:410-668-1599
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02184800183500000X
MD127351835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12735OtherPHARMACIST REGISTRATION N
MD28RI02184800OtherPHARMACIST REGISTRATION N