Provider Demographics
NPI:1982200903
Name:LE, NGOC NGAN THI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NGOC NGAN
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6540 LARRY WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-4012
Mailing Address - Country:US
Mailing Address - Phone:916-621-7243
Mailing Address - Fax:
Practice Address - Street 1:7506 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-1929
Practice Address - Country:US
Practice Address - Phone:209-951-1051
Practice Address - Fax:209-951-8572
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist