Provider Demographics
NPI:1639836760
Name:TRAN, PHUONG TRANG T
Entity Type:Individual
Prefix:
First Name:PHUONG TRANG
Middle Name:T
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 1:7101 MARTIN LUTHER KING JR WAY S STE 101B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3591
Mailing Address - Country:US
Mailing Address - Phone:206-721-5009
Mailing Address - Fax:206-721-3931
Practice Address - Street 1:7101 MARTIN LUTHER KING JR WAY S STE 101B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-3591
Practice Address - Country:US
Practice Address - Phone:206-721-5009
Practice Address - Fax:206-721-3931
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00058430183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician