Provider Demographics
NPI:1023391224
Name:BUI, XUAN THANH LE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:XUAN
Middle Name:THANH LE
Last Name:BUI
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 1:4884 LACOSTA CT SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5301
Mailing Address - Country:US
Mailing Address - Phone:770-322-8486
Mailing Address - Fax:770-322-7010
Practice Address - Street 1:2945 PANOLA RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2313
Practice Address - Country:US
Practice Address - Phone:770-322-8486
Practice Address - Fax:770-322-7410
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2024-06-24
Deactivation Date:2021-08-05
Deactivation Code:
Reactivation Date:2024-06-24
Provider Licenses
StateLicense IDTaxonomies
GARPH023602183500000X
MAPH26286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist