Provider Demographics
NPI:1427331743
Name:TRAN, PHAN LE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:PHAN
Middle Name:LE
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 1:3902 A ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-8610
Mailing Address - Country:US
Mailing Address - Phone:253-939-8563
Mailing Address - Fax:253-939-0869
Practice Address - Street 1:3902 A ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8610
Practice Address - Country:US
Practice Address - Phone:253-939-8563
Practice Address - Fax:253-939-0869
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00070936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist