Provider Demographics
NPI:1477116838
Name:TRAN, BETHANIE LAN NGOC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BETHANIE LAN
Middle Name:NGOC
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SAM WALTON LN
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7933
Mailing Address - Country:US
Mailing Address - Phone:303-688-8335
Mailing Address - Fax:
Practice Address - Street 1:133 SAM WALTON LN
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7933
Practice Address - Country:US
Practice Address - Phone:303-688-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-20
Last Update Date:2019-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist