Provider Demographics
NPI:1578162582
Name:TRAN, CAROLYN CHI (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:CHI
Last Name:TRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11867 WESTMINSTER CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4175
Mailing Address - Country:US
Mailing Address - Phone:909-831-6557
Mailing Address - Fax:
Practice Address - Street 1:1033 N WATERMAN AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3808
Practice Address - Country:US
Practice Address - Phone:909-884-2739
Practice Address - Fax:909-885-8880
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist