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General NPI Number Information
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NPI Number | 1487193850
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Entity Type | Individual
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Provider Name | MYAN TRAN
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Gender | Female
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Dates
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Enumeration Date | 02/18/2017
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Last Update Date | 02/18/2017
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Provider Practice Location Address
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Address Line | 820 SIR FRANCIS DRAKE BLVD
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City | SAN ANSELMO
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State | CA
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Zip | 94960-1906
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Country | US
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Telephone | 415-482-0191
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 655
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City | SAUSALITO
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State | CA
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Zip | 94966-0655
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Country | US
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Telephone | 408-506-8955
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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 | RPH76248
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License Number State | CA
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