Provider Demographics
NPI:1083826705
Name:NGUYEN, LEAH PHUONG L (PHARMD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:PHUONG L
Last Name:NGUYEN
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 1:4033 TALBOT RD S STE 260
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5767
Mailing Address - Country:US
Mailing Address - Phone:425-690-3533
Mailing Address - Fax:425-690-9147
Practice Address - Street 1:4033 TALBOT RD S STE 260
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5767
Practice Address - Country:US
Practice Address - Phone:425-690-3533
Practice Address - Fax:425-690-9147
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00062521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist