Provider Demographics
NPI:1386240679
Name:TRAN, TRANG MAI (PHARMD)
Entity type:Individual
Prefix:
First Name:TRANG
Middle Name:MAI
Last Name:TRAN
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 1:1109 FORT MARCY PARK
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3488
Mailing Address - Country:US
Mailing Address - Phone:678-637-6962
Mailing Address - Fax:
Practice Address - Street 1:4585 HARTLEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-5501
Practice Address - Country:US
Practice Address - Phone:478-781-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist