Healthcare Provider Details

I. General information

NPI: 1043531775
Provider Name (Legal Business Name): PHIE TRAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 100TH ST SW
LAKEWOOD WA
98499-2752
US

IV. Provider business mailing address

2521 87TH AVE W APT 240
UNIVERSITY PLACE WA
98466-1824
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-3666
  • Fax: 253-588-1922
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH 60096402
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: