Provider Demographics
NPI:1457636342
Name:TRAN DAC, THUY THANH
Entity Type:Individual
Prefix:
First Name:THUY
Middle Name:THANH
Last Name:TRAN DAC
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 1:110 CRICKLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9287
Mailing Address - Country:US
Mailing Address - Phone:702-292-9749
Mailing Address - Fax:
Practice Address - Street 1:11001 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2954
Practice Address - Country:US
Practice Address - Phone:702-948-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist