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General NPI Number Information
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NPI Number | 1376368647
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Entity Type | Individual
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Provider Name | TRACY THI TRAN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 129 W LOCUST ST
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City | DAVENPORT
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State | IA
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Zip | 52803-2803
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Country | US
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Telephone | 563-324-1641
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Fax |
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Provider Business Mailing Address
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Address Line | 1433 W PLEASANT ST
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City | DAVENPORT
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State | IA
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Zip | 52804-2123
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Country | US
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Telephone | 563-514-8918
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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 | 25205
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License Number State | IA
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