Healthcare Provider Details

I. General information

NPI: 1831461961
Provider Name (Legal Business Name): TRUC-QUYEN TRAN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 LOMAS BLVD NE TARGET #0357
ALBUQUERQUE NM
87112-5582
US

IV. Provider business mailing address

11120 LOMAS BLVD NE TARGET #0357
ALBUQUERQUE NM
87112-5582
US

V. Phone/Fax

Practice location:
  • Phone: 505-346-0193
  • Fax:
Mailing address:
  • Phone: 505-346-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00007501
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: