MEDICARE: ANTHONY B TRAN PHARM D RPH

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	120050	MN

General Provider Information

NPI Number	:	1912282104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY B TRAN PHARM D RPH

Provider Business Mailing Address
First Line	:	939 SCHALLER DR S
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55119-5843
Country	:	US
Telephone Number	:	651-983-4603
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3908
Country	:	US
Telephone Number	:	651-646-6163
Fax Number	:

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

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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