Provider Demographics
NPI:1629381181
Name:TRAN, MARK T (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
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:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:ME
Mailing Address - Zip Code:04971-0047
Mailing Address - Country:US
Mailing Address - Phone:203-526-3322
Mailing Address - Fax:
Practice Address - Street 1:36 MOOSEHEAD TRL
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4108
Practice Address - Country:US
Practice Address - Phone:207-368-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist