Provider Demographics
NPI:1043511041
Name:TRAN, TIN TRI (RPH)
Entity type:Individual
Prefix:MR
First Name:TIN
Middle Name:TRI
Last Name:TRAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 NE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2104
Mailing Address - Country:US
Mailing Address - Phone:503-261-2559
Mailing Address - Fax:503-261-2563
Practice Address - Street 1:221 NE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-2104
Practice Address - Country:US
Practice Address - Phone:503-261-2559
Practice Address - Fax:503-261-2563
Is Sole Proprietor?:No
Enumeration Date:2010-11-06
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0007541183500000X
OR75411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist