Provider Demographics
NPI:1821081910
Name:TRAN, BEATLE THIEN-PHUOC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BEATLE
Middle Name:THIEN-PHUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 JEFFERSON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3344
Mailing Address - Country:US
Mailing Address - Phone:916-371-2022
Mailing Address - Fax:916-371-2027
Practice Address - Street 1:1029 JEFFERSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3344
Practice Address - Country:US
Practice Address - Phone:916-371-2022
Practice Address - Fax:916-371-2027
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 50909183500000X
CA5527150001332B00000X
CAPHY 4708303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 470830Medicaid
CARPH 50909OtherPHARMACIST LICENSURE CA
CAPHY 47083OtherSTATE PHARMACY LICENSE
0550017OtherNCPDP
0550017OtherNCPDP
CARPH 50909OtherPHARMACIST LICENSURE CA