Provider Demographics
NPI:1790301760
Name:LE, BRANDON NGUYEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:NGUYEN
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 NAPA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2029
Mailing Address - Country:US
Mailing Address - Phone:408-963-8762
Mailing Address - Fax:
Practice Address - Street 1:2002 SCOTT BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6900
Practice Address - Country:US
Practice Address - Phone:408-963-8762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist