MEDICARE: THERESA TAM 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	53432	CA

General Provider Information

NPI Number	:	1609927060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA TAM TRAN RPH

Provider Business Mailing Address
First Line	:	14132 MOONCREST ST
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4716
Country	:	US
Telephone Number	:	714-893-0741
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 S BRISTOL ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-7302
Country	:	US
Telephone Number	:	714-540-0393
Fax Number	:	714-540-1442

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

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	07/08/2007

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