Provider Demographics
NPI:1265156582
Name:LE, MIMI UYEN (RPH)
Entity type:Individual
Prefix:
First Name:MIMI
Middle Name:UYEN
Last Name:LE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13061 ANSELL CT
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-3415
Mailing Address - Country:US
Mailing Address - Phone:714-837-3022
Mailing Address - Fax:
Practice Address - Street 1:859 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4070
Practice Address - Country:US
Practice Address - Phone:951-492-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist