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NPI Code Detail

MEDICARE: THU TRANG THI TRAN

MEDICARE:   THU TRANG THI TRAN
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
1183500000XPharmacist0202219311VA

General Provider Information

NPI Number : 1790362812
Entity Type Code : Individual
Provider Name (Legal Business Name) : THU TRANG THI TRAN
Provider Business Mailing Address
First Line : 2141 DALE AVE SE
Second Line :
City : ROANOKE
State : VA
Zip : 24013-2135
Country : US
Telephone Number : 540-613-6651
Fax Number :
Provider Business Practice Location Address
First Line : 2141 DALE AVE SE
Second Line :
City : ROANOKE
State : VA
Zip : 24013-2135
Country : US
Telephone Number : 540-613-6651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2021
Last Update Date : 03/25/2021

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Directions to “ THU TRANG THI TRAN ” Practice Location

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