Provider Demographics
NPI:1659417897
Name:LE, TIM THIEN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:THIEN
Last Name:LE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:TINH
Other - Middle Name:THIEN
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:5830 JAMESON CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0896
Mailing Address - Country:US
Mailing Address - Phone:916-220-3344
Mailing Address - Fax:
Practice Address - Street 1:5830 JAMESON CT
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0896
Practice Address - Country:US
Practice Address - Phone:916-220-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist