Provider Demographics
NPI:1063763183
Name:BUENROSTRO, AMY TRAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:TRAN
Last Name:BUENROSTRO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 SPRINGVALE ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-3764
Mailing Address - Country:US
Mailing Address - Phone:909-630-1861
Mailing Address - Fax:
Practice Address - Street 1:23781 MAQUINA
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2716
Practice Address - Country:US
Practice Address - Phone:949-455-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist