Provider Demographics
NPI:1548708001
Name:TRAN, KIMNGAN THI (RPH)
Entity type:Individual
Prefix:
First Name:KIMNGAN
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 E GOLF LINKS RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1232
Mailing Address - Country:US
Mailing Address - Phone:520-731-3098
Mailing Address - Fax:520-731-3246
Practice Address - Street 1:7901 E GOLF LINKS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1232
Practice Address - Country:US
Practice Address - Phone:520-731-3098
Practice Address - Fax:520-731-3246
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist