Provider Demographics
NPI:1124302120
Name:TRAN, BAONHAN (PHARM D)
Entity type:Individual
Prefix:
First Name:BAONHAN
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3453
Mailing Address - Country:US
Mailing Address - Phone:315-214-5097
Mailing Address - Fax:
Practice Address - Street 1:104 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2907
Practice Address - Country:US
Practice Address - Phone:315-492-0248
Practice Address - Fax:315-492-0250
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist