=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568664241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUYEN K TRAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 11/02/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3259 CATLIN AVE
-----------------------------------------------------
City | QUANTICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22134-5109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-784-1637
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5837 CUB STREAM DR
-----------------------------------------------------
City | CENTREVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20120-2926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-543-6084
-----------------------------------------------------
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 | 0202206849
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------