Provider Demographics
NPI:1881683191
Name:TRAN, PHU TRONG (RPH DPH)
Entity Type:Individual
Prefix:MR
First Name:PHU
Middle Name:TRONG
Last Name:TRAN
Suffix:
Gender:M
Credentials:RPH DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 E MILL ST
Mailing Address - Street 2:STE 14
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-1548
Mailing Address - Country:US
Mailing Address - Phone:909-387-0932
Mailing Address - Fax:909-381-3592
Practice Address - Street 1:385 E MILL ST
Practice Address - Street 2:STE 14
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1548
Practice Address - Country:US
Practice Address - Phone:909-387-0932
Practice Address - Fax:909-381-3592
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY37070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA370700Medicaid
0546931OtherNAPB
BP2837156OtherDEA