Provider Demographics
NPI:1770866931
Name:HUA, STACEY NHO TRAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:NHO TRAN
Last Name:HUA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24081 EL TORO RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3103
Mailing Address - Country:US
Mailing Address - Phone:949-206-9632
Mailing Address - Fax:949-206-1339
Practice Address - Street 1:24081 EL TORO RD
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3103
Practice Address - Country:US
Practice Address - Phone:949-206-9632
Practice Address - Fax:949-206-1339
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 58731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist