Healthcare Provider Details

I. General information

NPI: 1518238120
Provider Name (Legal Business Name): LE GIA BANH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9750 WOODMAN AVE
ARLETA CA
91331-6422
US

IV. Provider business mailing address

4949 BELLAIRE AVE
VALLEY VILLAGE CA
91607-3418
US

V. Phone/Fax

Practice location:
  • Phone: 818-899-9950
  • Fax: 818-899-0223
Mailing address:
  • Phone: 818-392-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: