Provider Demographics
NPI:1043822950
Name:TRAN, PETER LINH II
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:LINH
Last Name:TRAN
Suffix:II
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 1:15371 DEDEAUX RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3855
Mailing Address - Country:US
Mailing Address - Phone:228-539-9890
Mailing Address - Fax:228-539-0238
Practice Address - Street 1:15371 DEDEAUX RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3855
Practice Address - Country:US
Practice Address - Phone:228-539-9890
Practice Address - Fax:228-539-0238
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-14700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist