Healthcare Provider Details

I. General information

NPI: 1548696990
Provider Name (Legal Business Name): PHUONG T TRAN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IVIE TRAN

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 ROLLING HILLS CIRCLE
EASLEY SC
29640
US

IV. Provider business mailing address

309 ROLLING HILLS CIRCLE
EASLEY SC
29640
US

V. Phone/Fax

Practice location:
  • Phone: 864-644-9012
  • Fax: 864-644-9013
Mailing address:
  • Phone: 864-644-9012
  • Fax: 864-644-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14324
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: