Provider Demographics
NPI:1306119193
Name:LE, STEPHANIE NGA (RPH)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:NGA
Last Name:LE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 NE 148TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7135
Mailing Address - Country:US
Mailing Address - Phone:206-850-7276
Mailing Address - Fax:
Practice Address - Street 1:4615 196TH ST SW STE 114
Practice Address - Street 2:FRED MEYER - REGIONAL OFFICE
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5591
Practice Address - Country:US
Practice Address - Phone:425-582-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00020041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist