Healthcare Provider Details

I. General information

NPI: 1306756051
Provider Name (Legal Business Name): LOC DUY LE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 DECATUR HWY
FULTONDALE AL
35068-1742
US

IV. Provider business mailing address

31787 STATE HIGHWAY 79
CLEVELAND AL
35049-4707
US

V. Phone/Fax

Practice location:
  • Phone: 205-841-3815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24789
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: