Provider Demographics
NPI:1922147594
Name:LE, NGUYEN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:NGUYEN
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 N SPRING ST
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2814
Mailing Address - Country:US
Mailing Address - Phone:213-680-2198
Mailing Address - Fax:213-680-1806
Practice Address - Street 1:633 N SPRING ST
Practice Address - Street 2:SUITE # 5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2814
Practice Address - Country:US
Practice Address - Phone:213-680-2198
Practice Address - Fax:213-680-1806
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH39548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA324800Medicaid