Healthcare Provider Details

I. General information

NPI: 1679346217
Provider Name (Legal Business Name): VAN BINH TRAN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 BROADWAY ST
PEARLAND TX
77581-4507
US

IV. Provider business mailing address

13711 MISTY BLUFF DR
HOUSTON TX
77085-1323
US

V. Phone/Fax

Practice location:
  • Phone: 281-997-4400
  • Fax:
Mailing address:
  • Phone: 281-617-8776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73077
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: