Provider Demographics
NPI:1790132629
Name:TRAN, TIMOTHY NGUYEN-GIAP
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:NGUYEN-GIAP
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-4707
Mailing Address - Country:US
Mailing Address - Phone:540-387-2791
Mailing Address - Fax:847-396-2636
Practice Address - Street 1:1355 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-4707
Practice Address - Country:US
Practice Address - Phone:540-387-2791
Practice Address - Fax:847-396-2636
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist