Provider Demographics
NPI:1730464264
Name:TRAN, ANTHONY TRUNG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TRUNG
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 DAMASK CT
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8751
Mailing Address - Country:US
Mailing Address - Phone:714-331-0183
Mailing Address - Fax:
Practice Address - Street 1:3500 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1305
Practice Address - Country:US
Practice Address - Phone:209-341-0814
Practice Address - Fax:209-341-0849
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist