Provider Demographics
NPI:1649598400
Name:LE, ANH NGOC (RPH, CIP)
Entity Type:Individual
Prefix:MRS
First Name:ANH
Middle Name:NGOC
Last Name:LE
Suffix:
Gender:F
Credentials:RPH, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-5801
Mailing Address - Country:US
Mailing Address - Phone:909-886-1461
Mailing Address - Fax:909-881-0581
Practice Address - Street 1:949 KENDALL DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-5801
Practice Address - Country:US
Practice Address - Phone:909-886-1461
Practice Address - Fax:909-881-0581
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0009800804OtherKAISER