Basic Information
| Provider Information | |||||||||
| NPI: | 1659705218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | TERA | ||||||||
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| Credential: | PHARM. D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5252 BALBOA ARMS DR | ||||||||
| Address2: | 279 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921174987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587769686 | ||||||||
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| Practice Location | |||||||||
| Address1: | 480 ALTA RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921790001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196616500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2013 | ||||||||
| LastUpdateDate: | 08/30/2013 | ||||||||
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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 | RPH67888 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.