Healthcare Provider Details

I. General information

NPI: 1790392934
Provider Name (Legal Business Name): TYLER TRUNG THANH TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8337 SOUTHPARK CIR
ORLANDO FL
32819-9049
US

IV. Provider business mailing address

8337 SOUTHPARK CIR
ORLANDO FL
32819-9049
US

V. Phone/Fax

Practice location:
  • Phone: 888-782-8443
  • Fax:
Mailing address:
  • Phone: 888-782-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: