MEDICARE: MRS. DU PHU LE PHARM D

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	PS41460	FL

General Provider Information

NPI Number	:	1689911638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DU PHU LE PHARM D

Provider Business Mailing Address
First Line	:	11245 US HIGHWAY 301 N
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-8675
Country	:	US
Telephone Number	:	941-776-0890
Fax Number	:	941-776-8042

Provider Business Practice Location Address
First Line	:	11245 US HIGHWAY 301 N
Second Line	:
City	:	PARRISH
State	:	FL
Zip	:	34219-8675
Country	:	US
Telephone Number	:	941-776-0890
Fax Number	:	941-776-8042

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

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	01/10/2013

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