MEDICARE: PHU TRAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH028850	GA

General Provider Information

NPI Number	:	1043681083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHU TRAN PHARMD

Provider Business Mailing Address
First Line	:	2500 DALLAS HWY SW
Second Line	:	STE 300
City	:	MARIETTA
State	:	GA
Zip	:	30064-2567
Country	:	US
Telephone Number	:	770-426-3256
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 DALLAS HWY SW
Second Line	:	STE 300
City	:	MARIETTA
State	:	GA
Zip	:	30064-2567
Country	:	US
Telephone Number	:	770-426-3256
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	11/02/2015

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