Provider Demographics
NPI:1477005015
Name:TRAN, NGOC THU NGUYEN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NGOC THU
Middle Name:NGUYEN
Last Name:TRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 SWARTZ FAIRBANKS RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-9707
Mailing Address - Country:US
Mailing Address - Phone:318-267-4330
Mailing Address - Fax:
Practice Address - Street 1:522 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4252
Practice Address - Country:US
Practice Address - Phone:318-343-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist