Provider Demographics
NPI:1518272046
Name:LE, NGUYET THU (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NGUYET
Middle Name:THU
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 PAR PL
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-6411
Mailing Address - Country:US
Mailing Address - Phone:562-463-9934
Mailing Address - Fax:
Practice Address - Street 1:1208 W REDONDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3411
Practice Address - Country:US
Practice Address - Phone:310-323-4768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 45343183500000X
CA45343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist