Healthcare Provider Details

I. General information

NPI: 1205209566
Provider Name (Legal Business Name): THAO TRAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10455 S DE ANZA BLVD
CUPERTINO CA
95014-3011
US

IV. Provider business mailing address

10455 S DE ANZA BLVD
CUPERTINO CA
95014-3011
US

V. Phone/Fax

Practice location:
  • Phone: 408-996-1911
  • Fax: 408-996-9925
Mailing address:
  • Phone: 408-996-1911
  • Fax: 408-996-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: