Provider Demographics
NPI:1841569472
Name:TRAN, THOAI THAI (BS PHARM)
Entity Type:Individual
Prefix:
First Name:THOAI
Middle Name:THAI
Last Name:TRAN
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N ALAFAYA TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3206
Mailing Address - Country:US
Mailing Address - Phone:407-273-2721
Mailing Address - Fax:407-273-5409
Practice Address - Street 1:3000 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828
Practice Address - Country:US
Practice Address - Phone:407-273-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS036035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist