=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063998938
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW TRAN RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2018
-----------------------------------------------------
Last Update Date | 07/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27350 SUN CITY BLVD
-----------------------------------------------------
City | SUN CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92586-2596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-301-0063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3141 E COAST HWY
-----------------------------------------------------
City | CORONA DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92625-2330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-675-0414
-----------------------------------------------------
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 | 78491
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------