MEDICARE: MR. DAT THANH TRAN B.S. PHARMACY

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	28RI02184800	NJ
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	12735	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12735	OTHER	MD	PHARMACIST REGISTRATION N
2	28RI02184800	OTHER	MD	PHARMACIST REGISTRATION N

General Provider Information

NPI Number	:	1336317544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAT THANH TRAN B.S. PHARMACY

Provider Business Mailing Address
First Line	:	1704 FALLSTON RD
Second Line	:
City	:	FALLSTON
State	:	MD
Zip	:	21047-1415
Country	:	US
Telephone Number	:	443-455-0410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 CLEANLEIGH DR
Second Line	:
City	:	PARKVILLE
State	:	MD
Zip	:	21234-6808
Country	:	US
Telephone Number	:	410-668-0980
Fax Number	:	410-668-1599

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

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	06/14/2019

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