MEDICARE: THAO TRAN

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	1-110737	KS

General Provider Information

NPI Number	:	1669084752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THAO TRAN

Provider Business Mailing Address
First Line	:	1308 E KANSAS AVE
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5804
Country	:	US
Telephone Number	:	620-275-4430
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 E KANSAS AVE
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5804
Country	:	US
Telephone Number	:	620-275-4430
Fax Number	:

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

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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Directions to “ THAO TRAN ” Practice Location

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