Provider Demographics
NPI:1275197790
Name:LE, PRISCILLA QUYNH (PHARMD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:QUYNH
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MENAUL BLVD NE UNIT 3506
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1550
Mailing Address - Country:US
Mailing Address - Phone:575-528-8704
Mailing Address - Fax:
Practice Address - Street 1:1820 UNSER BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3933
Practice Address - Country:US
Practice Address - Phone:505-600-4293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist