MEDICARE: NGA THANH TRAN RPH

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	14992	NV
2	183500000X	Pharmacist	16019	CO
3	183500000X	Pharmacist	PH00060413	WA

General Provider Information

NPI Number	:	1407048556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGA THANH TRAN RPH

Provider Business Mailing Address
First Line	:	10654 PUEBLO SPRINGS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4684
Country	:	US
Telephone Number	:	310-387-2150
Fax Number	:

Provider Business Practice Location Address
First Line	:	10654 PUEBLO SPRINGS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-4684
Country	:	US
Telephone Number	:	310-387-2150
Fax Number	:

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/14/2007

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