Provider Demographics
NPI:1780035568
Name:TRAN, YVONNE KIM
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:KIM
Last Name:TRAN
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 1:5812 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PRT RCHY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-6050
Mailing Address - Country:US
Mailing Address - Phone:727-846-1300
Mailing Address - Fax:727-846-1310
Practice Address - Street 1:5812 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PRT RCHY
Practice Address - State:FL
Practice Address - Zip Code:34652-6050
Practice Address - Country:US
Practice Address - Phone:727-846-1300
Practice Address - Fax:727-846-1310
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist