Provider Demographics
NPI:1962114496
Name:TRAN, ALPHONSUS
Entity type:Individual
Prefix:
First Name:ALPHONSUS
Middle Name:
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 1:1330 PARK WEST GREEN DR APT 2105
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3960
Mailing Address - Country:US
Mailing Address - Phone:832-310-8694
Mailing Address - Fax:
Practice Address - Street 1:1330 PARK WEST GREEN DR APT 2105
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3960
Practice Address - Country:US
Practice Address - Phone:832-310-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist