Provider Demographics
NPI:1487257473
Name:LAI-TRAN, DIANA (RPH)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:LAI-TRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 REVERE BEACH PKWY
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-1454
Mailing Address - Country:US
Mailing Address - Phone:617-884-1095
Mailing Address - Fax:617-884-2089
Practice Address - Street 1:1010 REVERE BEACH PKWY
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-1454
Practice Address - Country:US
Practice Address - Phone:617-884-1095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist