Provider Demographics
NPI:1013445170
Name:THAI LE, JIMMY HIEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JIMMY HIEN
Middle Name:
Last Name:THAI LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:JIMMY
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6862 RIVERRUN CT
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3437
Mailing Address - Country:US
Mailing Address - Phone:951-332-1594
Mailing Address - Fax:
Practice Address - Street 1:3944 GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5422
Practice Address - Country:US
Practice Address - Phone:909-364-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist