Provider Demographics
NPI:1477684785
Name:TRAN, DUYEN THI (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:DUYEN
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N EUCLID ST
Mailing Address - Street 2:#A
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3029
Mailing Address - Country:US
Mailing Address - Phone:714-554-7155
Mailing Address - Fax:714-554-7155
Practice Address - Street 1:122 N EUCLID ST
Practice Address - Street 2:#A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3029
Practice Address - Country:US
Practice Address - Phone:714-554-7155
Practice Address - Fax:714-554-7155
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH45895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA408410Medicaid
CAPHA408410Medicaid