Provider Demographics
NPI:1790323012
Name:TRAN, THAO
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:
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 1:3022 N FRANCISCO WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-5307
Mailing Address - Country:US
Mailing Address - Phone:925-813-2727
Mailing Address - Fax:
Practice Address - Street 1:WALGREENS
Practice Address - Street 2:3416 DEER VALLEY ROAD
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-9450
Practice Address - Country:US
Practice Address - Phone:925-978-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH81119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist