Provider Demographics
NPI:1417558768
Name:TRAN, SERINA
Entity Type:Individual
Prefix:
First Name:SERINA
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 1:1320 HWY 290 E
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-2128
Mailing Address - Country:US
Mailing Address - Phone:512-285-3649
Mailing Address - Fax:512-285-3689
Practice Address - Street 1:1320 HWY 290 E
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-2128
Practice Address - Country:US
Practice Address - Phone:512-285-3649
Practice Address - Fax:512-285-3689
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist