MEDICARE: DR. TAN DUY TRAN PHARM D

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	64759	CA

General Provider Information

NPI Number	:	1043816937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAN DUY TRAN PHARM D

Provider Business Mailing Address
First Line	:	15180 KENSINGTON PARK DR
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-1801
Country	:	US
Telephone Number	:	714-259-7625
Fax Number	:

Provider Business Practice Location Address
First Line	:	15180 KENSINGTON PARK DR
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-1801
Country	:	US
Telephone Number	:	714-259-7625
Fax Number	:	714-259-4849

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

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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