Healthcare Provider Details

I. General information

NPI: 1730758186
Provider Name (Legal Business Name): DAVID THANH TRAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 E GREGORY BLVD STE A
RAYTOWN MO
64133-6523
US

IV. Provider business mailing address

7500 METCALF AVE
OVERLAND PARK KS
66204-2926
US

V. Phone/Fax

Practice location:
  • Phone: 816-608-8139
  • Fax: 855-813-5433
Mailing address:
  • Phone: 913-318-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-103121
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2017026898
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: