Provider Demographics
NPI:1922471945
Name:TRAN, BAO PHUOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:BAO PHUOC
Middle Name:
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 1:14262 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4562
Mailing Address - Country:US
Mailing Address - Phone:714-622-5992
Mailing Address - Fax:714-248-9516
Practice Address - Street 1:14262 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4562
Practice Address - Country:US
Practice Address - Phone:714-622-5992
Practice Address - Fax:714-248-9516
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist