Provider Demographics
NPI:1669526844
Name:LE, ANDY THANH (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ANDY
Middle Name:THANH
Last Name:LE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:THANH
Other - Middle Name:TRUONG
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3931 CHANTILLY RD
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3310
Mailing Address - Country:US
Mailing Address - Phone:703-378-1867
Mailing Address - Fax:
Practice Address - Street 1:11445 SUNSET HILLS RD
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5276
Practice Address - Country:US
Practice Address - Phone:703-709-1652
Practice Address - Fax:703-709-1744
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist