Provider Demographics
NPI:1871193011
Name:TRAN, TUNG M
Entity Type:Individual
Prefix:
First Name:TUNG
Middle Name:M
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13817 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3243
Mailing Address - Country:US
Mailing Address - Phone:727-593-0316
Mailing Address - Fax:727-593-0583
Practice Address - Street 1:13817 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3243
Practice Address - Country:US
Practice Address - Phone:727-593-0316
Practice Address - Fax:727-593-0583
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist