Provider Demographics
NPI:1912282104
Name:TRAN, ANTHONY B (PHARM D RPH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARM D RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 SCHALLER DR S
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5843
Mailing Address - Country:US
Mailing Address - Phone:651-983-4603
Mailing Address - Fax:
Practice Address - Street 1:1550 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3908
Practice Address - Country:US
Practice Address - Phone:651-646-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist