Provider Demographics
NPI:1639451313
Name:LE, PHONG THANH (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:PHONG
Middle Name:THANH
Last Name:LE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ALYSSA DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1341
Mailing Address - Country:US
Mailing Address - Phone:215-601-3002
Mailing Address - Fax:215-579-2102
Practice Address - Street 1:25 ALYSSA DR
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1341
Practice Address - Country:US
Practice Address - Phone:215-601-3002
Practice Address - Fax:215-579-2102
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist