Provider Demographics
NPI:1336537869
Name:TRAN, TRUNG ANH (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:ANH
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 1:4067 PERALTA BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4849
Mailing Address - Country:US
Mailing Address - Phone:510-793-5096
Mailing Address - Fax:510-797-2112
Practice Address - Street 1:4067 PERALTA BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4849
Practice Address - Country:US
Practice Address - Phone:510-793-5096
Practice Address - Fax:510-797-2112
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist