=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689233199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TUAN ANH TRAN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2019
-----------------------------------------------------
Last Update Date | 06/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 S MERCEY SPRINGS RD
-----------------------------------------------------
City | LOS BANOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93635-4928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-829-7915
-----------------------------------------------------
Fax | 209-829-1681
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3155 GOLF DR
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95127-1427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-666-6946
-----------------------------------------------------
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 | 78008
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------