Provider Demographics
NPI:1033854492
Name:LE, MICHELLE PHUONG UYEN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PHUONG UYEN
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8931 ERNEST FULSOM DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-4606
Mailing Address - Country:US
Mailing Address - Phone:714-653-0169
Mailing Address - Fax:
Practice Address - Street 1:1500 E GAGE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1724
Practice Address - Country:US
Practice Address - Phone:323-581-0964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86044183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist