Provider Demographics
NPI:1366843666
Name:TRAN, LOAN III
Entity Type:Individual
Prefix:MRS
First Name:LOAN
Middle Name:
Last Name:TRAN
Suffix:III
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 1:6057 BROGAN WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5458
Mailing Address - Country:US
Mailing Address - Phone:408-828-3042
Mailing Address - Fax:
Practice Address - Street 1:3935 PARK DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4579
Practice Address - Country:US
Practice Address - Phone:916-933-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist