Provider Demographics
NPI:1851669485
Name:TRAN, MIKAELA THUY-TRANG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIKAELA
Middle Name:THUY-TRANG
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24890 N LAKE PLEASANT PKWY
Mailing Address - Street 2:T2227
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1348
Mailing Address - Country:US
Mailing Address - Phone:623-376-7301
Mailing Address - Fax:623-376-7301
Practice Address - Street 1:24890 N LAKE PLEASANT PKWY
Practice Address - Street 2:T2227
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1348
Practice Address - Country:US
Practice Address - Phone:623-376-7301
Practice Address - Fax:623-376-7301
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist