Individual
BAOTRAM VAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1481 W 10TH ST # 119, INDIANAPOLIS, IN 46202-2803
(317) 988-9331
Mailing address
232 E VINELAND RD, AUGUSTA, GA 30904-3414
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Enumeration date
07/17/2020
Last updated
07/17/2020
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