Provider Demographics
NPI:1184261273
Name:TRAN, HIEU TRUNG (RPH)
Entity type:Individual
Prefix:
First Name:HIEU
Middle Name:TRUNG
Last Name:TRAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 GALLOWAY WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-6362
Mailing Address - Country:US
Mailing Address - Phone:916-230-1431
Mailing Address - Fax:
Practice Address - Street 1:115 LAKE BLVD E
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2913
Practice Address - Country:US
Practice Address - Phone:530-229-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist