Provider Demographics
NPI:1568910115
Name:TRAN, KIM YEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIM YEN
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:41650 W MARICOPA CASA GRANDE HWY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-3206
Mailing Address - Country:US
Mailing Address - Phone:520-568-3302
Mailing Address - Fax:
Practice Address - Street 1:41650 W MARICOPA CASA GRANDE HWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-3206
Practice Address - Country:US
Practice Address - Phone:520-568-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist