MEDICARE: TRI MINH TRAN PHARMACY DOCTORATE

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	67990	CA

General Provider Information

NPI Number	:	1871938068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRI MINH TRAN PHARMACY DOCTORATE

Provider Business Mailing Address
First Line	:	15914 BENICHIA CIR
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-1001
Country	:	US
Telephone Number	:	262-664-3979
Fax Number	:

Provider Business Practice Location Address
First Line	:	11983 HAWTHORNE BLVD
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-3015
Country	:	US
Telephone Number	:	310-349-0130
Fax Number	:

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

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	02/13/2014

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