MEDICARE: MR. LOC KHAC LE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S012817	AZ
2	183500000X	Pharmacist	1219	AZ

General Provider Information

NPI Number	:	1275864241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOC KHAC LE PHARMD

Provider Business Mailing Address
First Line	:	500 S 99TH AVE
Second Line	:
City	:	TOLLESON
State	:	AZ
Zip	:	85353-9700
Country	:	US
Telephone Number	:	623-907-4932
Fax Number	:	623-907-4990

Provider Business Practice Location Address
First Line	:	2858 N PINAL AVE
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-7917
Country	:	US
Telephone Number	:	520-426-4701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	11/03/2014

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