Provider Demographics
NPI:1316488687
Name:TRAN, BAO (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BAO
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-3110
Mailing Address - Country:US
Mailing Address - Phone:225-261-3049
Mailing Address - Fax:225-261-9709
Practice Address - Street 1:6515 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-3110
Practice Address - Country:US
Practice Address - Phone:225-261-3049
Practice Address - Fax:225-261-9709
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021943183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist