Healthcare Provider Details

I. General information

NPI: 1841695467
Provider Name (Legal Business Name): ANGELICA TRAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WASHINGTON AVE N
KENT WA
98032-4438
US

IV. Provider business mailing address

455 BRONSON WAY NORTH EAST
RENTON WA
98056
US

V. Phone/Fax

Practice location:
  • Phone: 253-373-0156
  • Fax:
Mailing address:
  • Phone: 206-293-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60477712
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: