Provider Demographics
NPI:1992005987
Name:TRAN, THANH
Entity type:Individual
Prefix:MR
First Name:THANH
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 1:1901 S TEXAS AVE
Mailing Address - Street 2:WALMART NEIGHBORHOOD MARKET PHARMACY
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-1832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 S TEXAS AVE
Practice Address - Street 2:WALMART NEIGHBORHOOD MARKET PHARMACY
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1832
Practice Address - Country:US
Practice Address - Phone:979-599-5562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043227L183500000X
TX52217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist