Healthcare Provider Details

I. General information

NPI: 1124410329
Provider Name (Legal Business Name): HIEU TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HOSPITAL CIRCLE
BROWNING MT
59417
US

IV. Provider business mailing address

PO BOX 760
BROWNING MT
59417-0760
US

V. Phone/Fax

Practice location:
  • Phone: 407-338-8908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: