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NPI Code Detail

MEDICARE: TRACY HUYEN TRAM PHAN PHARM.D

MEDICARE: TRACY HUYEN TRAM PHAN 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
1183500000XPharmacistRPH59485CA

General Provider Information

NPI Number : 1659688638
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY HUYEN TRAM PHAN PHARM.D
Provider Business Mailing Address
First Line : 4130 LAKE PLACID CT
Second Line :
City : ANTELOPE
State : CA
Zip : 95843-5267
Country : US
Telephone Number : 916-218-9099
Fax Number :
Provider Business Practice Location Address
First Line : 4300 ELVERTA RD
Second Line :
City : ANTELOPE
State : CA
Zip : 95843-6700
Country : US
Telephone Number : 916-218-9099
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2010
Last Update Date : 09/11/2010

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