Provider Demographics
NPI:1861896920
Name:LE, WAYNE NGUYEN (RPH)
Entity type:Individual
Prefix:
First Name:WAYNE NGUYEN
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:NGUYEN
Other - Middle Name:D
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 S LONE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5348
Mailing Address - Country:US
Mailing Address - Phone:909-394-7978
Mailing Address - Fax:909-394-7957
Practice Address - Street 1:1301 S LONE HILL AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5348
Practice Address - Country:US
Practice Address - Phone:909-394-7978
Practice Address - Fax:909-394-7957
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist