Provider Demographics
NPI:1689119620
Name:TRAN, KRISTY THANH VAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:THANH VAN
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 1:4038 N TERRA MESA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1475
Mailing Address - Country:US
Mailing Address - Phone:480-364-1568
Mailing Address - Fax:
Practice Address - Street 1:1375 S ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6500
Practice Address - Country:US
Practice Address - Phone:480-364-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist