Provider Demographics
NPI:1902180342
Name:TRAN, TUAN KIET VAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:TUAN KIET
Middle Name:VAN
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 1:18510 LODGEPOLE PINE ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1407
Mailing Address - Country:US
Mailing Address - Phone:515-571-2807
Mailing Address - Fax:
Practice Address - Street 1:18510 LODGEPOLE PINE ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1407
Practice Address - Country:US
Practice Address - Phone:515-571-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist