Provider Demographics
NPI:1124302823
Name:LE, THANH PHUONG THI (PHARMD)
Entity type:Individual
Prefix:
First Name:THANH PHUONG
Middle Name:THI
Last Name:LE
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 1:3999 SANTA RITA RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3462
Mailing Address - Country:US
Mailing Address - Phone:925-460-8552
Mailing Address - Fax:925-460-5147
Practice Address - Street 1:3999 SANTA RITA RD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-460-8552
Practice Address - Fax:925-460-5147
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2018-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist