Provider Demographics
NPI:1285707604
Name:LE, VAN P
Entity type:Individual
Prefix:
First Name:VAN
Middle Name:P
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N LENZ DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-1728
Mailing Address - Country:US
Mailing Address - Phone:714-758-9712
Mailing Address - Fax:
Practice Address - Street 1:1673 W BROADWAY STE 1
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1109
Practice Address - Country:US
Practice Address - Phone:714-772-3630
Practice Address - Fax:714-772-3631
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY40768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist