MEDICARE: PETER TRAN

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	28RI03800300	NJ

General Provider Information

NPI Number	:	1174068605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER TRAN

Provider Business Mailing Address
First Line	:	6419 GRAYS AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-2334
Country	:	US
Telephone Number	:	215-876-7047
Fax Number	:

Provider Business Practice Location Address
First Line	:	6419 GRAYS AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-2334
Country	:	US
Telephone Number	:	215-876-7047
Fax Number	:

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

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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Directions to “ PETER TRAN ” Practice Location

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