Provider Demographics
NPI:1629441084
Name:TRAN, TRACY HONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:HONG
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12504 OAK KNOLL RD APT 13
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5467
Mailing Address - Country:US
Mailing Address - Phone:858-380-9120
Mailing Address - Fax:
Practice Address - Street 1:535 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4209
Practice Address - Country:US
Practice Address - Phone:619-291-3705
Practice Address - Fax:619-291-8502
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist