Provider Demographics
NPI:1932776838
Name:TRAN, QUAN TUYET
Entity Type:Individual
Prefix:
First Name:QUAN
Middle Name:TUYET
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N GALLOWAY AVE # CL120
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2433
Mailing Address - Country:US
Mailing Address - Phone:214-320-7049
Mailing Address - Fax:866-924-3043
Practice Address - Street 1:1011 N GALLOWAY AVE # CL120
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2433
Practice Address - Country:US
Practice Address - Phone:214-320-7049
Practice Address - Fax:866-934-3043
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist