Provider Demographics
NPI:1861535098
Name:TRAN-LY, MIMI NGOC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MIMI
Middle Name:NGOC
Last Name:TRAN-LY
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 1:12691 HERON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6637
Mailing Address - Country:US
Mailing Address - Phone:571-213-7179
Mailing Address - Fax:
Practice Address - Street 1:5999 BURKE COMMONS RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2880
Practice Address - Country:US
Practice Address - Phone:703-249-7919
Practice Address - Fax:703-249-7787
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205760183500000X
MD17584183500000X
DCPH100000497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist