Provider Demographics
NPI:1467052308
Name:TRAN, VAN-PHUONG NGUYEN
Entity Type:Individual
Prefix:
First Name:VAN-PHUONG
Middle Name:NGUYEN
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 1:16048 KINGS MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4530
Mailing Address - Country:US
Mailing Address - Phone:571-224-8958
Mailing Address - Fax:
Practice Address - Street 1:16375 MERCHANTS LN
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-5655
Practice Address - Country:US
Practice Address - Phone:540-413-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist