Healthcare Provider Details

I. General information

NPI: 1659854065
Provider Name (Legal Business Name): NAM NGUYEN TRI TRAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 S REVERE PKWY STE 200
CENTENNIAL CO
80112-3931
US

IV. Provider business mailing address

7307 S REVERE PKWY STE 200
CENTENNIAL CO
80112-3931
US

V. Phone/Fax

Practice location:
  • Phone: 303-355-4745
  • Fax: 303-322-7022
Mailing address:
  • Phone: 303-355-4745
  • Fax: 303-322-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.0019595
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: