Provider Demographics
NPI:1720820269
Name:LE, LAN T (RPH)
Entity type:Individual
Prefix:
First Name:LAN
Middle Name:T
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 1:615 S EUCLID ST UNIT B4
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-1750
Mailing Address - Country:US
Mailing Address - Phone:714-902-3892
Mailing Address - Fax:
Practice Address - Street 1:16995 WALNUT GROVE DR
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4440
Practice Address - Country:US
Practice Address - Phone:408-779-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist