Provider Demographics
NPI:1629312087
Name:TRAN, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 W CUMBERLAND RD
Mailing Address - Street 2:APT 1023
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2051 W CUMBERLAND RD
Practice Address - Street 2:APT 1023
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5343
Practice Address - Country:US
Practice Address - Phone:903-360-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist