Provider Demographics
NPI:1063091957
Name:TRAN, QUYEN
Entity type:Individual
Prefix:
First Name:QUYEN
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6700
Mailing Address - Country:US
Mailing Address - Phone:781-397-0050
Mailing Address - Fax:781-397-7541
Practice Address - Street 1:99 CHARLES ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6700
Practice Address - Country:US
Practice Address - Phone:781-397-0050
Practice Address - Fax:781-397-7541
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist