Provider Demographics
NPI:1134716582
Name:TRUONG, TRINI TRANG (RPH)
Entity type:Individual
Prefix:
First Name:TRINI
Middle Name:TRANG
Last Name:TRUONG
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 1:2 CROSS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2303
Mailing Address - Country:US
Mailing Address - Phone:617-833-7185
Mailing Address - Fax:
Practice Address - Street 1:427 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2639
Practice Address - Country:US
Practice Address - Phone:617-783-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64478183500000X
MAPH237769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist