Provider Demographics
NPI:1376099812
Name:TA, JAMIE TRANG (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:TRANG
Last Name:TA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:255 W HERNDON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0381
Mailing Address - Country:US
Mailing Address - Phone:559-324-1808
Mailing Address - Fax:559-324-1876
Practice Address - Street 1:255 W HERNDON AVE
Practice Address - Street 2:STE 101
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0381
Practice Address - Country:US
Practice Address - Phone:559-324-1808
Practice Address - Fax:559-324-1876
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARPH 59312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist