Provider Demographics
NPI:1285901363
Name:LE, MARCIE HOANG (BS)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:HOANG
Last Name:LE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9461 SHADWELL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7213
Mailing Address - Country:US
Mailing Address - Phone:714-968-0695
Mailing Address - Fax:
Practice Address - Street 1:6012 WARNER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5568
Practice Address - Country:US
Practice Address - Phone:714-375-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA427CAMERONMedicaid
CA427CAMERONMedicare Oscar/Certification
CA427CAMERONMedicare UPIN