Provider Demographics
NPI:1407131923
Name:LE, MAN NGUYEN-TRI (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:MAN
Middle Name:NGUYEN-TRI
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 1:3100 NATOMA CIR
Mailing Address - Street 2:
Mailing Address - City:THOMPSONS STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37179-9605
Mailing Address - Country:US
Mailing Address - Phone:615-400-6689
Mailing Address - Fax:
Practice Address - Street 1:4932 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2726
Practice Address - Country:US
Practice Address - Phone:615-302-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist