MEDICARE: HEALTHPRO ALLIANCE LLC

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	333600000X	Pharmacy	PH25962	FL

General Provider Information

NPI Number	:	1992079289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHPRO ALLIANCE LLC

Provider Business Mailing Address
First Line	:	990 N SR 434
Second Line	:	SUITE 1128
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7035
Country	:	US
Telephone Number	:	407-865-7977
Fax Number	:	407-865-7975

Provider Business Practice Location Address
First Line	:	990 N SR 434
Second Line	:	SUITE 1128
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7035
Country	:	US
Telephone Number	:	407-865-7977
Fax Number	:	407-865-7975

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. THONG MINH TRAN
Credential	:
Telephone Number	:	407-865-7977

Provider Enumeration Date	:	03/04/2012
Last Update Date	:	03/04/2012

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