Provider Demographics
NPI:1770183287
Name:VO, DAI TRANG
Entity Type:Individual
Prefix:
First Name:DAI
Middle Name:TRANG
Last Name:VO
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 1:7715 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-2119
Mailing Address - Country:US
Mailing Address - Phone:918-851-2523
Mailing Address - Fax:
Practice Address - Street 1:12200 S WACO AVE
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-5655
Practice Address - Country:US
Practice Address - Phone:918-299-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist