MEDICARE: CAM NHUNG THI 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	53968	TX

General Provider Information

NPI Number	:	1386291680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAM NHUNG THI TRAN PHARMD

Provider Business Mailing Address
First Line	:	2717 PECAN MEADOW DR
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-3983
Country	:	US
Telephone Number	:	310-503-3918
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 N BEACH ST STE 105
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6432
Country	:	US
Telephone Number	:	318-503-3918
Fax Number	:

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

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	08/21/2019

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