Provider Demographics
NPI:1649690439
Name:TRAN-TAN, NGUYEN-KHANG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NGUYEN-KHANG
Middle Name:
Last Name:TRAN-TAN
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 1:1186 KIELDER CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-4513
Mailing Address - Country:US
Mailing Address - Phone:423-999-7627
Mailing Address - Fax:
Practice Address - Street 1:7000 CALMONT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-4183
Practice Address - Country:US
Practice Address - Phone:682-303-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37504183500000X
TX56959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist