Provider Demographics
NPI:1518568153
Name:LE NGUYEN, JOHNNY DINH
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:DINH
Last Name:LE NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SW 24TH AVE APT 1813
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7839
Mailing Address - Country:US
Mailing Address - Phone:225-205-3843
Mailing Address - Fax:
Practice Address - Street 1:2600 SW 19TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1393
Practice Address - Country:US
Practice Address - Phone:352-237-7103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist