Provider Demographics
NPI:1053623496
Name:LE, VAN QUANG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:QUANG
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 FRAYSER BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127
Mailing Address - Country:US
Mailing Address - Phone:901-353-0639
Mailing Address - Fax:901-353-2198
Practice Address - Street 1:2655 FRAYSER BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127
Practice Address - Country:US
Practice Address - Phone:901-353-0639
Practice Address - Fax:901-353-2198
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist