Provider Demographics
NPI:1134466808
Name:LE, DAN QUANG (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:QUANG
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 1:2300 S CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8416
Mailing Address - Country:US
Mailing Address - Phone:407-277-9124
Mailing Address - Fax:407-207-2301
Practice Address - Street 1:2300 S CHICKASAW TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8416
Practice Address - Country:US
Practice Address - Phone:407-277-9124
Practice Address - Fax:407-207-2301
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist