Healthcare Provider Details

I. General information

NPI: 1760348676
Provider Name (Legal Business Name): KEVIN QUOC LE PHARMD, BCACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MASSACHUSETTS AVE FL 6
BOSTON MA
02118-2605
US

IV. Provider business mailing address

27 WHEATLAND ST
SOMERVILLE MA
02145-2013
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5951
  • Fax:
Mailing address:
  • Phone: 802-578-9904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH1002485
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: