Provider Demographics
NPI:1043567373
Name:LE, HUNG THANH (RPH)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:THANH
Last Name:LE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14561 SE 154TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-8117
Mailing Address - Country:US
Mailing Address - Phone:425-272-1908
Mailing Address - Fax:
Practice Address - Street 1:1605 S 93RD ST STE EB
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-5112
Practice Address - Country:US
Practice Address - Phone:206-767-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH39897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist