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General NPI Number Information
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NPI Number | 1295252633
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Entity Type | Individual
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Provider Name | KELLY SUONG TRAM PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 08/26/2017
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Last Update Date | 08/26/2017
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Provider Practice Location Address
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Address Line | 1015A DELAWARE AVE
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City | MCCOMB
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State | MS
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Zip | 39648-3831
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Country | US
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Telephone | 601-250-5516
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 STONEGATE DR
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City | MCCOMB
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State | MS
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Zip | 39648-7402
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Country | US
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Telephone | 225-772-5434
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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 | T-010273
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License Number State | MS
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