Provider Demographics
NPI:1073890539
Name:LE, THANH (PHARM D)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W FAIRCHILD ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3841
Mailing Address - Country:US
Mailing Address - Phone:217-442-7388
Mailing Address - Fax:217-442-2695
Practice Address - Street 1:400 W FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3841
Practice Address - Country:US
Practice Address - Phone:217-442-7388
Practice Address - Fax:217-442-2695
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051292033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051292033OtherREGISTERED PHARMACIST