Provider Demographics
NPI:1306313424
Name:LE, XUANLAM HOANG (PHARMACIST)
Entity type:Individual
Prefix:
First Name:XUANLAM
Middle Name:HOANG
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9431 BEVAN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6511
Mailing Address - Country:US
Mailing Address - Phone:714-889-0877
Mailing Address - Fax:
Practice Address - Street 1:5125 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3937
Practice Address - Country:US
Practice Address - Phone:559-252-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist