1730464264 NPI number — DR. ANTHONY TRUNG TRAN PHARM.D

Table of content: DR. ANTHONY TRUNG TRAN PHARM.D (NPI 1730464264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730464264 NPI number — DR. ANTHONY TRUNG TRAN PHARM.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAN
Provider First Name:
ANTHONY
Provider Middle Name:
TRUNG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730464264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2780 DAMASK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANTECA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95337-8751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-331-0183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 COFFEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95355-1305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-341-0814
Provider Business Practice Location Address Fax Number:
209-341-0849
Provider Enumeration Date:
10/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  62843 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com