Provider Demographics
NPI:1013507268
Name:LE, NGOC NGUYEN THAO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NGOC
Middle Name:NGUYEN THAO
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 MCKEE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5023
Mailing Address - Country:US
Mailing Address - Phone:608-772-7991
Mailing Address - Fax:
Practice Address - Street 1:2033 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-1238
Practice Address - Country:US
Practice Address - Phone:608-268-0355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20616-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist