MEDICARE: QUYEN ANH 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1285356584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUYEN ANH TRAN

Provider Business Mailing Address
First Line	:	64 MISTY MESA TRL # 2
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-4854
Country	:	US
Telephone Number	:	817-682-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 US 287 HWY
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-2800
Country	:	US
Telephone Number	:	817-478-1313
Fax Number	:

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

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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