Healthcare Provider Details

I. General information

NPI: 1235638560
Provider Name (Legal Business Name): VI VI MY TRAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10120 MASON AVE
CHATSWORTH CA
91311-3301
US

IV. Provider business mailing address

PO BOX 183
MIDWAY CITY CA
92655-0183
US

V. Phone/Fax

Practice location:
  • Phone: 818-349-7213
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number78187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: