Healthcare Provider Details

I. General information

NPI: 1720491921
Provider Name (Legal Business Name): BELLA TRAN PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 LANSDOWNE AVE
PHILADELPHIA PA
19131-3935
US

IV. Provider business mailing address

5440 LANSDOWNE AVE
PHILADELPHIA PA
19131-3935
US

V. Phone/Fax

Practice location:
  • Phone: 215-877-1506
  • Fax:
Mailing address:
  • Phone: 215-877-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP447053
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: