MEDICARE: LAN-ANH TERESA TRAN PHARMD

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	1167183	TX

General Provider Information

NPI Number	:	1356945117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAN-ANH TERESA TRAN PHARMD

Provider Business Mailing Address
First Line	:	4333 WESTERN CENTER BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2036
Country	:	US
Telephone Number	:	817-307-3503
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 WESTERN CENTER BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2036
Country	:	US
Telephone Number	:	817-232-1634
Fax Number	:

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	12/03/2020

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