MEDICARE: MRS. TRAM LE KHANH DINH PHARMACIST

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	56939	CA

General Provider Information

NPI Number	:	1609143833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRAM LE KHANH DINH PHARMACIST

Provider Business Mailing Address
First Line	:	1330 E 17TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-8500
Country	:	US
Telephone Number	:	714-547-1042
Fax Number	:	714-547-1042

Provider Business Practice Location Address
First Line	:	1330 E 17TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705
Country	:	US
Telephone Number	:	714-547-1042
Fax Number	:	714-547-1042

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

Provider Enumeration Date	:	11/16/2011
Last Update Date	:	11/16/2011

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