Provider Demographics
NPI:1992253314
Name:LE, NAM PHUONG TRUONG (PHARMD)
Entity type:Individual
Prefix:
First Name:NAM PHUONG
Middle Name:TRUONG
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NAM-PHUONG
Other - Middle Name:D
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1044 JUNESONG WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1154
Mailing Address - Country:US
Mailing Address - Phone:408-660-7876
Mailing Address - Fax:
Practice Address - Street 1:1350 S PARK VICTORIA DR
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6941
Practice Address - Country:US
Practice Address - Phone:408-263-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist