MEDICARE: TRANG T PHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	15354	OK

General Provider Information

NPI Number	:	1083207716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRANG T PHAN

Provider Business Mailing Address
First Line	:	4110 RUFFIN CT
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73025-0825
Country	:	US
Telephone Number	:	405-509-4269
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 NW 12TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-4800
Country	:	US
Telephone Number	:	405-232-8631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2021
Last Update Date	:	02/13/2021

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Directions to “ TRANG T PHAN ” Practice Location

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