Healthcare Provider Details

I. General information

NPI: 1982242590
Provider Name (Legal Business Name): AMY TRAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N BISHOP ST
BISHOP CA
93514
US

IV. Provider business mailing address

374 E PINE ST
BISHOP CA
93514-2835
US

V. Phone/Fax

Practice location:
  • Phone: 760-872-8114
  • Fax:
Mailing address:
  • Phone: 562-400-8331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: