Provider Demographics
NPI:1043885668
Name:DONG, ANNE LE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LE
Last Name:DONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 HESPERIDES AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8128
Mailing Address - Country:US
Mailing Address - Phone:702-767-1194
Mailing Address - Fax:
Practice Address - Street 1:3550 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5867
Practice Address - Country:US
Practice Address - Phone:702-873-7171
Practice Address - Fax:702-873-9860
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist