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General NPI Number Information
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NPI Number | 1659800670
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Entity Type | Individual
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Provider Name | ALEXANDER TRAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 420 POLIFKA DR BLDG 1042
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City | SHAW AFB
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State | SC
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Zip | 29152-5100
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Country | US
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Telephone | 803-895-6625
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Fax |
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Provider Business Mailing Address
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Address Line | 420 POLIFKA DR BLDG 1042
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City | SHAW AFB
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State | SC
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Zip | 29152-5100
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Country | US
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Telephone | 803-895-6625
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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 | 0021953
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 0002005950
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License Number State | CO
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