MEDICARE: KIM T 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	051.292127	IL

General Provider Information

NPI Number	:	1225310964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM T TRAN PHARM.D.

Provider Business Mailing Address
First Line	:	2924 E 92ND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4503
Country	:	US
Telephone Number	:	773-721-6603
Fax Number	:	773-721-2003

Provider Business Practice Location Address
First Line	:	2924 E 92ND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-4503
Country	:	US
Telephone Number	:	773-721-6603
Fax Number	:	773-721-2003

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

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	09/19/2011

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Directions to “ KIM T TRAN PHARM.D.” Practice Location

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