Provider Demographics
NPI:1932444346
Name:TRAN, JENNIFER DIEM (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DIEM
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 ARMSTRONG WAY APT A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6343
Mailing Address - Country:US
Mailing Address - Phone:909-919-5711
Mailing Address - Fax:
Practice Address - Street 1:183 ARMSTRONG WAY APT A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6343
Practice Address - Country:US
Practice Address - Phone:909-919-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67988183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist