MEDICARE: LEAH PHUONG L NGUYEN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH00062521	WA

General Provider Information

NPI Number	:	1083826705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH PHUONG L NGUYEN PHARMD

Provider Business Mailing Address
First Line	:	4033 TALBOT RD S STE 260
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5767
Country	:	US
Telephone Number	:	425-690-3533
Fax Number	:	425-690-9147

Provider Business Practice Location Address
First Line	:	4033 TALBOT RD S STE 260
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5767
Country	:	US
Telephone Number	:	425-690-3533
Fax Number	:	425-690-9147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	10/31/2024

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