Provider Demographics
NPI:1811597495
Name:TRAN, THUY THU
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:THU
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 1:6770 WESTWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTWORTH VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76114-4002
Mailing Address - Country:US
Mailing Address - Phone:817-570-0827
Mailing Address - Fax:817-570-0415
Practice Address - Street 1:6770 WESTWORTH BLVD
Practice Address - Street 2:
Practice Address - City:WESTWORTH VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76114-4002
Practice Address - Country:US
Practice Address - Phone:817-570-0827
Practice Address - Fax:817-570-0415
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist