Provider Demographics
NPI:1538461876
Name:TRA, THONG QUANG (BS PHARM)
Entity Type:Individual
Prefix:MR
First Name:THONG
Middle Name:QUANG
Last Name:TRA
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23632 HIGHWAY 99
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-9211
Mailing Address - Country:US
Mailing Address - Phone:425-775-1030
Mailing Address - Fax:425-774-1780
Practice Address - Street 1:23632 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9211
Practice Address - Country:US
Practice Address - Phone:425-775-1030
Practice Address - Fax:425-774-1780
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00022164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist