MEDICARE: THUY THU 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	48512	TX

General Provider Information

NPI Number	:	1811597495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THUY THU TRAN

Provider Business Mailing Address
First Line	:	6770 WESTWORTH BLVD
Second Line	:
City	:	WESTWORTH VILLAGE
State	:	TX
Zip	:	76114-4002
Country	:	US
Telephone Number	:	817-570-0827
Fax Number	:	817-570-0415

Provider Business Practice Location Address
First Line	:	6770 WESTWORTH BLVD
Second Line	:
City	:	WESTWORTH VILLAGE
State	:	TX
Zip	:	76114-4002
Country	:	US
Telephone Number	:	817-570-0827
Fax Number	:	817-570-0415

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

Provider Enumeration Date	:	10/31/2020
Last Update Date	:	10/31/2020

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Directions to “ THUY THU TRAN ” Practice Location

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