Provider Demographics
NPI:1245521285
Name:TRAN, SUONG BANG
Entity type:Individual
Prefix:MS
First Name:SUONG
Middle Name:BANG
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3589 PATRICIA ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-3861
Mailing Address - Country:US
Mailing Address - Phone:901-388-2724
Mailing Address - Fax:
Practice Address - Street 1:3500 RAMILL RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3300
Practice Address - Country:US
Practice Address - Phone:901-388-3902
Practice Address - Fax:901-386-9626
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist