Provider Demographics
NPI:1811264567
Name:LE, THIEN THANH CAT (PHARM D)
Entity type:Individual
Prefix:
First Name:THIEN THANH
Middle Name:CAT
Last Name:LE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7646 SE 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6352
Mailing Address - Country:US
Mailing Address - Phone:503-453-6469
Mailing Address - Fax:
Practice Address - Street 1:619 NW 6TH AVE FL 7
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3964
Practice Address - Country:US
Practice Address - Phone:503-988-9843
Practice Address - Fax:503-988-4345
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0012884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist