Provider Demographics
NPI:1912501164
Name:TRAN, QUYEN TO
Entity Type:Individual
Prefix:
First Name:QUYEN
Middle Name:TO
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 1:57 ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-3116
Mailing Address - Country:US
Mailing Address - Phone:617-331-5065
Mailing Address - Fax:781-331-1636
Practice Address - Street 1:57 ISLAND AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-3116
Practice Address - Country:US
Practice Address - Phone:617-331-5065
Practice Address - Fax:781-331-1636
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH257631835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care