Provider Demographics
NPI:1144660564
Name:LE, JUDY THANH (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:THANH
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9439
Mailing Address - Country:US
Mailing Address - Phone:530-283-1188
Mailing Address - Fax:
Practice Address - Street 1:40 E MAIN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9701
Practice Address - Country:US
Practice Address - Phone:530-283-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist