Provider Demographics
NPI:1558980383
Name:LE, QUYNH NHU PHAM (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:QUYNH NHU
Middle Name:PHAM
Last Name:LE
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 1:829 S BALSAM ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8902
Mailing Address - Country:US
Mailing Address - Phone:712-574-9013
Mailing Address - Fax:
Practice Address - Street 1:1215 141ST ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-8127
Practice Address - Country:US
Practice Address - Phone:515-465-3543
Practice Address - Fax:515-465-9467
Is Sole Proprietor?:No
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1314Medicaid