Provider Demographics
NPI:1497466213
Name:TRAN, CAT TIEN M
Entity Type:Individual
Prefix:MS
First Name:CAT TIEN
Middle Name:M
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 1:343 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3376
Mailing Address - Country:US
Mailing Address - Phone:617-305-3599
Mailing Address - Fax:617-302-3056
Practice Address - Street 1:343 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-3376
Practice Address - Country:US
Practice Address - Phone:617-305-3599
Practice Address - Fax:617-302-3056
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist