MEDICARE: NGA THI KIM LE BS

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	0202208776	VA

General Provider Information

NPI Number	:	1518250646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGA THI KIM LE BS

Provider Business Mailing Address
First Line	:	2329 SHORE SANDS CT APT 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-7308
Country	:	US
Telephone Number	:	757-416-5712
Fax Number	:	757-416-5712

Provider Business Practice Location Address
First Line	:	2800 ARCTIC AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-3040
Country	:	US
Telephone Number	:	757-422-2154
Fax Number	:	757-422-3221

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

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	05/23/2011

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