Provider Demographics
NPI:1376827972
Name:LE, ANH-VIET PHAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANH-VIET
Middle Name:PHAM
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 51ST ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3123
Mailing Address - Country:US
Mailing Address - Phone:480-330-3362
Mailing Address - Fax:
Practice Address - Street 1:3955 51ST ST APT 3C
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3123
Practice Address - Country:US
Practice Address - Phone:480-330-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61533183500000X
AZS15583183500000X
NY056733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist