Healthcare Provider Details

I. General information

NPI: 1962758854
Provider Name (Legal Business Name): JONATHAN TRAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2012
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12254 BELLFLOWER BLVD PHARMACY INFORMATICS
DOWNEY CA
90242-2804
US

IV. Provider business mailing address

PO BOX 309
SAN GABRIEL CA
91778-0309
US

V. Phone/Fax

Practice location:
  • Phone: 800-823-4040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: