Healthcare Provider Details

I. General information

NPI: 1730514837
Provider Name (Legal Business Name): CUONG DUY TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2013
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11425 W BUCKEYE RD
AVONDALE AZ
85323-6810
US

IV. Provider business mailing address

8633 W LOCKLAND CT
PEORIA AZ
85382-4725
US

V. Phone/Fax

Practice location:
  • Phone: 623-907-6161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS020037
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: