MEDICARE: MR. DIEP NGOC 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	RP040891L	PA

General Provider Information

NPI Number	:	1679555783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DIEP NGOC TRAN RPH

Provider Business Mailing Address
First Line	:	326 SAYBROOK RD
Second Line	:
City	:	VILLANOVA
State	:	PA
Zip	:	19085-1718
Country	:	US
Telephone Number	:	215-324-8477
Fax Number	:

Provider Business Practice Location Address
First Line	:	5012 OLD YORK ROAD
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19141
Country	:	US
Telephone Number	:	215-324-8477
Fax Number	:

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	02/17/2016

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