MEDICARE: VINH 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	5412596-1701	UT
2	183500000X	Pharmacist	PH60247604	WA

General Provider Information

NPI Number	:	1699051201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINH TRAN PHARMD

Provider Business Mailing Address
First Line	:	5678 SHADY PINE LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-6046
Country	:	US
Telephone Number	:	801-652-4560
Fax Number	:

Provider Business Practice Location Address
First Line	:	5678 SHADY PINE LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84118-6046
Country	:	US
Telephone Number	:	801-652-4560
Fax Number	:

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

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	10/26/2011

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