=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023905015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THAOVY MAI TRAN RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2025
-----------------------------------------------------
Last Update Date | 06/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8364 BYRON CENTER AVE SW
-----------------------------------------------------
City | BYRON CENTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49315-7805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-878-0497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 863 COBBLESTONE WAY DR SE
-----------------------------------------------------
City | BYRON CENTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49315-7971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-724-0327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302417453
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------