=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689082133
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LE & NGUYEN PACIFIC PHARMACY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2014
-----------------------------------------------------
Last Update Date | 10/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10515 MCFADDEN AVE STE 104
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-260-9094
-----------------------------------------------------
Fax | 714-849-5764
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10515 MCFADDEN AVE STE 104
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-260-9094
-----------------------------------------------------
Fax | 714-849-5764
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER,MGR,PIC,AO
-----------------------------------------------------
Name | NANCY LE
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 714-230-5106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 53660
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------