Provider Demographics
NPI:1417457870
Name:LEBLANC, PHILLIP NGUYEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:NGUYEN
Last Name:LEBLANC
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 1:789 BAYVIEW PL
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2601
Mailing Address - Country:US
Mailing Address - Phone:949-338-0762
Mailing Address - Fax:949-338-0762
Practice Address - Street 1:244 FOREST AVE
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2114
Practice Address - Country:US
Practice Address - Phone:949-494-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist