MEDICARE: DR. BEATLE THIEN-PHUOC TRAN PHARMD

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	RPH 50909	CA
2	332B00000X	Durable Medical Equipment & Medical Supplies	5527150001	CA
3	3336C0003X	Community/Retail Pharmacy	PHY 470830	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	RPH 50909	OTHER	CA	PHARMACIST LICENSURE CA
3	PHY 47083	OTHER	CA	STATE PHARMACY LICENSE
4	0550017	OTHER		NCPDP

General Provider Information

NPI Number	:	1821081910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEATLE THIEN-PHUOC TRAN PHARMD

Provider Business Mailing Address
First Line	:	1029 JEFFERSON BLVD
Second Line	:	SUITE A
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3344
Country	:	US
Telephone Number	:	916-371-2022
Fax Number	:	916-371-2027

Provider Business Practice Location Address
First Line	:	1029 JEFFERSON BLVD
Second Line	:	SUITE A
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3344
Country	:	US
Telephone Number	:	916-371-2022
Fax Number	:	916-371-2027

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/07/2023

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