Healthcare Provider Details

I. General information

NPI: 1255681912
Provider Name (Legal Business Name): JAMES Q LE PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 06/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 S KIRKWOOD RD
KIRKWOOD MO
63122-7200
US

IV. Provider business mailing address

1042 S KIRKWOOD RD
KIRKWOOD MO
63122-7200
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-4865
  • Fax:
Mailing address:
  • Phone: 314-822-4865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2012033292
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2012031289
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: