Healthcare Provider Details

I. General information

NPI: 1609283209
Provider Name (Legal Business Name): MRS. TRAM THU VAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 W 21ST ST N
WICHITA KS
67203-2105
US

IV. Provider business mailing address

1910 W 21ST ST N
WICHITA KS
67203-2105
US

V. Phone/Fax

Practice location:
  • Phone: 316-838-9508
  • Fax: 316-838-7239
Mailing address:
  • Phone: 316-838-9508
  • Fax: 316-838-7239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12356
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: