Healthcare Provider Details

I. General information

NPI: 1659862001
Provider Name (Legal Business Name): STACY TRAN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 04/24/2023
Certification Date: 04/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 MISSION AVE
OCEANSIDE CA
92058-7803
US

IV. Provider business mailing address

PO BOX 8031
FOUNTAIN VALLEY CA
92728-8031
US

V. Phone/Fax

Practice location:
  • Phone: 760-433-9634
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: