Provider Demographics
NPI:1881286342
Name:LE, TIFFANY PHUONG UYEN (RPH)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:PHUONG UYEN
Last Name:LE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20507 SARTELL DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3549
Mailing Address - Country:US
Mailing Address - Phone:909-979-0575
Mailing Address - Fax:
Practice Address - Street 1:611 S BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3580
Practice Address - Country:US
Practice Address - Phone:714-778-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist