Provider Demographics
NPI:1598046823
Name:TRAN, TANGO T (RPH)
Entity Type:Individual
Prefix:
First Name:TANGO
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-2018
Mailing Address - Country:US
Mailing Address - Phone:610-532-1034
Mailing Address - Fax:610-532-1056
Practice Address - Street 1:52 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-2018
Practice Address - Country:US
Practice Address - Phone:610-532-1034
Practice Address - Fax:610-532-1056
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044180Y183500000X
CARPH63980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist