Active NPI
Mathew Tran, PHARMD
- Pharmacist
- Tucker, GA
National Provider Identifier
1235742461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH032309
- Practice address
- 3959 Lavista Rd Ste a
Tucker, GA 30084-5152 - Phone
- (770) 934-6442
- NPI assigned
- Aug 27, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH032309 | GA | Primary |
Addresses
Primary practice location
3959 Lavista Rd Ste a
Tucker, GA 30084-5152
Mailing address
PO Box 1551
Dacula, GA 30019-0027
Phone (678) 631-6612
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH032309 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Co | Past | Accepting new patients | |
| The Kroger Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Bethlehem, GA
- NPI 1154294205
-
- Community/Retail Pharmacy
- Tucker, GA
- NPI 1821013525
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598486400000",
"number": "1235742461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1551",
"city": "DACULA",
"state": "GA",
"postal_code": "300190027",
"telephone_number": "678-631-6612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3959 LAVISTA RD STE A",
"city": "TUCKER",
"state": "GA",
"postal_code": "300845152",
"telephone_number": "770-934-6442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAN",
"first_name": "MATHEW",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-27",
"last_updated": "2020-08-27",
"certification_date": "2020-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH032309",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.