Provider Demographics
NPI:1467778910
Name:GAGNE-FONGEMIE, TRANG LE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRANG
Middle Name:LE
Last Name:GAGNE-FONGEMIE
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 1:11311 BRIDGEPORT WAY SW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3071
Mailing Address - Country:US
Mailing Address - Phone:253-985-6790
Mailing Address - Fax:253-985-6705
Practice Address - Street 1:11311 BRIDGEPORT WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-985-6790
Practice Address - Fax:253-985-6705
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00021571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH 00021571OtherPHARMACIST LICENSE