Healthcare Provider Details

I. General information

NPI: 1902829062
Provider Name (Legal Business Name): LOC TAN TRAN PHARM-D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 E SUNSET RD
LAS VEGAS NV
89120-3233
US

IV. Provider business mailing address

5694 CALANAS AVE
LAS VEGAS NV
89141-3951
US

V. Phone/Fax

Practice location:
  • Phone: 702-458-4004
  • Fax: 702-454-3053
Mailing address:
  • Phone: 702-809-3061
  • Fax: 702-454-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14361
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: