MEDICARE: TINA THAO 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	79844	CA

General Provider Information

NPI Number	:	1467929380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA THAO TRAN PHARMD

Provider Business Mailing Address
First Line	:	9513 CARNATION AVE
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1506
Country	:	US
Telephone Number	:	714-606-3859
Fax Number	:

Provider Business Practice Location Address
First Line	:	9882 ADAMS AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-4808
Country	:	US
Telephone Number	:	714-849-1815
Fax Number	:

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

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	10/29/2018

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