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General NPI Number Information
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NPI Number | 1689288151
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Entity Type | Individual
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Provider Name | KHANH PHUONG TRAN
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Gender | Female
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 1470 KELLER PKWY
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City | KELLER
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State | TX
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Zip | 76248-3619
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Country | US
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Telephone | 817-431-5305
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Fax |
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Provider Business Mailing Address
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Address Line | 10505 CRAWFORD FARMS DR
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City | FORT WORTH
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State | TX
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Zip | 76244-9595
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Country | US
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Telephone | 817-559-3149
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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 | 40945
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License Number State | TX
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