Provider Demographics
NPI:1700404548
Name:TRAN, VITA CHAU (RPH)
Entity Type:Individual
Prefix:DR
First Name:VITA
Middle Name:CHAU
Last Name:TRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CHARLESGATE E APT 206
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2324
Mailing Address - Country:US
Mailing Address - Phone:603-264-4985
Mailing Address - Fax:
Practice Address - Street 1:1890 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1047
Practice Address - Country:US
Practice Address - Phone:617-445-5457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist