Provider Demographics
NPI:1891270039
Name:NGUYEN, JOHNNY THANH LE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:THANH LE
Last Name:NGUYEN
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 1:610 E WINE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-1062
Mailing Address - Country:US
Mailing Address - Phone:509-882-1060
Mailing Address - Fax:
Practice Address - Street 1:610 E WINE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1062
Practice Address - Country:US
Practice Address - Phone:509-882-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60856319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist