Provider Demographics
NPI:1902521024
Name:LE-NGUYEN, VAN
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:LE-NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 E US HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1908
Mailing Address - Country:US
Mailing Address - Phone:816-313-0673
Mailing Address - Fax:
Practice Address - Street 1:11601 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1908
Practice Address - Country:US
Practice Address - Phone:816-313-0673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220358941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist