Provider Demographics
NPI:1982003711
Name:TRAN, PHUONG KIM (PHARM D)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 E ADMIRAL DOYLE DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-6308
Mailing Address - Country:US
Mailing Address - Phone:337-364-3841
Mailing Address - Fax:337-364-3843
Practice Address - Street 1:1205 E ADMIRAL DOYLE DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-6308
Practice Address - Country:US
Practice Address - Phone:337-364-3841
Practice Address - Fax:337-364-3843
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist