Provider Demographics
NPI:1861721979
Name:TRAN, TRUNG QUOC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRUNG
Middle Name:QUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764-7121
Mailing Address - Country:US
Mailing Address - Phone:432-580-0166
Mailing Address - Fax:432-337-1326
Practice Address - Street 1:307 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-5701
Practice Address - Country:US
Practice Address - Phone:432-599-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist