Provider Demographics
NPI:1568050680
Name:TRAN, STACEY BAO (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:BAO
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11724 MANISTIQUE WAY
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-4429
Mailing Address - Country:US
Mailing Address - Phone:727-643-9262
Mailing Address - Fax:
Practice Address - Street 1:11938 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1055
Practice Address - Country:US
Practice Address - Phone:727-868-9408
Practice Address - Fax:727-862-5351
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist