Healthcare Provider Details

I. General information

NPI: 1699444729
Provider Name (Legal Business Name): NATHAN H TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10675 W INDIAN SCHOOL RD
AVONDALE AZ
85392-5645
US

IV. Provider business mailing address

10914 W ASHBROOK PL
AVONDALE AZ
85392-3710
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-0502
  • Fax:
Mailing address:
  • Phone: 714-718-2289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS025246
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: