1467778910 NPI number — DR. TRANG LE GAGNE-FONGEMIE PHARMD

Table of content: DR. TRANG LE GAGNE-FONGEMIE PHARMD (NPI 1467778910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467778910 NPI number — DR. TRANG LE GAGNE-FONGEMIE PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAGNE-FONGEMIE
Provider First Name:
TRANG
Provider Middle Name:
LE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467778910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11311 BRIDGEPORT WAY SW
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-3071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-985-6790
Provider Business Mailing Address Fax Number:
253-985-6705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11311 BRIDGEPORT WAY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-985-6790
Provider Business Practice Location Address Fax Number:
253-985-6705
Provider Enumeration Date:
04/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH 00021571 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PH 00021571 . This is a "PHARMACIST LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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