Healthcare Provider Details

I. General information

NPI: 1427327097
Provider Name (Legal Business Name): ALI TRAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E HAMMER LN
STOCKTON CA
95210-4119
US

IV. Provider business mailing address

1616 E HAMMER LN
STOCKTON CA
95210-4119
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-7448
  • Fax: 209-478-7523
Mailing address:
  • Phone: 209-478-7448
  • Fax: 209-478-7523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: