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General NPI Number Information
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NPI Number | 1114623501
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Entity Type | Individual
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Provider Name | THANH NGOC DANG TRAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 6651 W FRANKLIN RD
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City | BOISE
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State | ID
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Zip | 83709-0914
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Country | US
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Telephone | 208-489-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 4909 N ELSINORE AVE APT N302
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City | MERIDIAN
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State | ID
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Zip | 83646-6979
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Country | US
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Telephone | 541-740-2285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P10463
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License Number State | ID
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