Healthcare Provider Details

I. General information

NPI: 1699080895
Provider Name (Legal Business Name): TINA TRAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19975 SW TUALATIN VALLEY HWY
ALOHA OR
97006-2323
US

IV. Provider business mailing address

6895 SW 169TH PL
BEAVERTON OR
97007-6319
US

V. Phone/Fax

Practice location:
  • Phone: 503-848-7297
  • Fax:
Mailing address:
  • Phone: 503-548-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH0012327
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: