Provider Demographics
NPI:1598129660
Name:LE, PHUONG-DUNG
Entity Type:Individual
Prefix:
First Name:PHUONG-DUNG
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BALMY BEACH DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5937
Mailing Address - Country:US
Mailing Address - Phone:407-457-6293
Mailing Address - Fax:407-457-6298
Practice Address - Street 1:820 BALMY BEACH DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5937
Practice Address - Country:US
Practice Address - Phone:407-457-6293
Practice Address - Fax:407-457-6298
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008367183500000X
TX55858183500000X
FLPS55868183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist