MEDICARE: DR. WILTON N TRAN PHARM.D.

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	PS 54235	FL

General Provider Information

NPI Number	:	1114373933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILTON N TRAN PHARM.D.

Provider Business Mailing Address
First Line	:	4702 E VINEYARD RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6423
Country	:	US
Telephone Number	:	602-820-4160
Fax Number	:

Provider Business Practice Location Address
First Line	:	4702 E VINEYARD RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6423
Country	:	US
Telephone Number	:	602-820-4160
Fax Number	:

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

Provider Enumeration Date	:	05/11/2016
Last Update Date	:	05/11/2016

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