Provider Demographics
NPI:1770232514
Name:TRAN, CHRISTINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
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 1:22169 HIGHWAY 102
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AR
Mailing Address - Zip Code:72722-8949
Mailing Address - Country:US
Mailing Address - Phone:515-943-1274
Mailing Address - Fax:
Practice Address - Street 1:612 S 12TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4702
Practice Address - Country:US
Practice Address - Phone:794-243-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist