Provider Demographics
NPI:1659159382
Name:LE, NANCY MAILAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MAILAN
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 1:1170 SAN MORITZ DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2751
Mailing Address - Country:US
Mailing Address - Phone:408-627-1918
Mailing Address - Fax:
Practice Address - Street 1:32980 ALVARADO NILES RD STE 836
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3186
Practice Address - Country:US
Practice Address - Phone:510-477-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist