Basic Information
| Provider Information | |||||||||
| NPI: | 1275864241 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | LOC | ||||||||
| MiddleName: | KHAC | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 S 99TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOLLESON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853539700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239074932 | ||||||||
| FaxNumber: | 6239074990 | ||||||||
| Practice Location | |||||||||
| Address1: | 2858 N PINAL AVE | ||||||||
| Address2: | |||||||||
| City: | CASA GRANDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851227917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204264701 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2010 | ||||||||
| LastUpdateDate: | 11/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | S012817 | AZ | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 1219 | AZ | N | Pharmacy Service Providers | Pharmacist |
No ID Information.