Provider Demographics
NPI:1871938068
Name:TRAN, TRI MINH (PHARMACY DOCTORATE)
Entity type:Individual
Prefix:
First Name:TRI
Middle Name:MINH
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARMACY DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15914 BENICHIA CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1001
Mailing Address - Country:US
Mailing Address - Phone:262-664-3979
Mailing Address - Fax:
Practice Address - Street 1:11983 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3015
Practice Address - Country:US
Practice Address - Phone:310-349-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist