Provider Demographics
NPI:1194074799
Name:TRAN, ANTHONY TRUNG
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TRUNG
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16199 BOONES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4201
Mailing Address - Country:US
Mailing Address - Phone:503-635-6630
Mailing Address - Fax:
Practice Address - Street 1:12121 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3737
Practice Address - Country:US
Practice Address - Phone:971-361-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0011793183500000X
OR0011793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist