MEDICARE: TRANG 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	PS64927	FL

General Provider Information

NPI Number	:	1194441774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRANG PHAN

Provider Business Mailing Address
First Line	:	5345 66TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-3125
Country	:	US
Telephone Number	:	727-548-5768
Fax Number	:

Provider Business Practice Location Address
First Line	:	5345 66TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-3125
Country	:	US
Telephone Number	:	727-548-5768
Fax Number	:	727-548-5761

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

Provider Enumeration Date	:	10/17/2022
Last Update Date	:	10/17/2022

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Directions to “ TRANG PHAN ” Practice Location

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