Provider Demographics
NPI:1215099346
Name:KRUG, MAYA TUYETMAI LE (PHARMD)
Entity type:Individual
Prefix:
First Name:MAYA TUYETMAI
Middle Name:LE
Last Name:KRUG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:LE
Other - Last Name:KRUG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:12254 BELLFLOWER BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2804
Mailing Address - Country:US
Mailing Address - Phone:562-658-3802
Mailing Address - Fax:
Practice Address - Street 1:12254 BELLFLOWER BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2804
Practice Address - Country:US
Practice Address - Phone:562-658-3802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist