Provider Demographics
NPI:1487860243
Name:LE, BAO QUY TRAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BAO
Middle Name:QUY TRAN
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2091 FENCELINE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6267
Mailing Address - Country:US
Mailing Address - Phone:916-984-3094
Mailing Address - Fax:916-852-1728
Practice Address - Street 1:2115 GOLDEN CENTRE LN
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-4477
Practice Address - Country:US
Practice Address - Phone:916-638-2735
Practice Address - Fax:916-852-1728
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist