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General NPI Number Information
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NPI Number | 1417457870
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Entity Type | Individual
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Provider Name | PHILLIP NGUYEN LEBLANC PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 244 FOREST AVE
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2114
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Country | US
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Telephone | 949-494-1059
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Fax |
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Provider Business Mailing Address
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Address Line | 789 BAYVIEW PL
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2601
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Country | US
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Telephone | 949-338-0762
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Fax | 949-338-0762
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 54348
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License Number State | CA
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