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NPI Code Detail

MEDICARE: MATTHEW TRAN

MEDICARE: MATTHEW 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
1183500000XPharmacist26026681AIN

General Provider Information

NPI Number : 1245794015
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW TRAN
Provider Business Mailing Address
First Line : 2139 HANOVER RD
Second Line :
City : BROWNSBURG
State : IN
Zip : 46112-7531
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5349 W PIKE PLAZA RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-3011
Country : US
Telephone Number : 317-387-2410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2019
Last Update Date : 01/25/2019

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