Healthcare Provider Details

I. General information

NPI: 1043675366
Provider Name (Legal Business Name): TU-UYEN LE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081-B CLAIREMONT DRIVE
SAN DIEGO CA
92117
US

IV. Provider business mailing address

11232 SIRIUS RD
SAN DIEGO CA
92126
US

V. Phone/Fax

Practice location:
  • Phone: 619-275-1175
  • Fax:
Mailing address:
  • Phone: 714-362-4134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number68688
License Number StateCA

VIII. Authorized Official

Name: TU-UYEN LE
Title or Position: PHARMACIST
Credential:
Phone: 714-362-4134