Provider Demographics
NPI:1275763146
Name:LE, TANH NGUYEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:TANH
Middle Name:NGUYEN
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 1:7400 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-4312
Mailing Address - Country:US
Mailing Address - Phone:267-350-9481
Mailing Address - Fax:267-350-9481
Practice Address - Street 1:7400 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-4312
Practice Address - Country:US
Practice Address - Phone:267-350-9481
Practice Address - Fax:267-350-9481
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist