Provider Demographics
NPI:1942578786
Name:LE, NHAT PHUONG T
Entity Type:Individual
Prefix:
First Name:NHAT PHUONG
Middle Name:T
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1326 N 182 ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022
Mailing Address - Country:US
Mailing Address - Phone:402-770-2558
Mailing Address - Fax:
Practice Address - Street 1:6005 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134
Practice Address - Country:US
Practice Address - Phone:402-201-2729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist