Basic Information
| Provider Information | |||||||||
| NPI: | 1003395666 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | MINH | ||||||||
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| Credential: | PHARMD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7675 NORMAL AVE | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919416148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197560539 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16773 BERNARDO CENTER DR | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921282525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584512630 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 77716 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.