MEDICARE: KHANH TRINH

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	03129381	OH

General Provider Information

NPI Number	:	1235438706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANH TRINH

Provider Business Mailing Address
First Line	:	2148 LAKE AVE
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-3436
Country	:	US
Telephone Number	:	440-993-0906
Fax Number	:

Provider Business Practice Location Address
First Line	:	2148 LAKE AVE
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-3436
Country	:	US
Telephone Number	:	440-993-0906
Fax Number	:

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

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	03/22/2011

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Directions to “ KHANH TRINH ” Practice Location

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