Provider Demographics
NPI:1962724401
Name:TRAN, LOAN THUY (PHARMD)
Entity type:Individual
Prefix:
First Name:LOAN
Middle Name:THUY
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 1:11332 FOUNTAINGROVE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6457
Mailing Address - Country:US
Mailing Address - Phone:704-491-4374
Mailing Address - Fax:704-547-8663
Practice Address - Street 1:8538 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3421
Practice Address - Country:US
Practice Address - Phone:704-547-8551
Practice Address - Fax:704-547-8663
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0609059Medicaid