Healthcare Provider Details

I. General information

NPI: 1376406959
Provider Name (Legal Business Name): STEPHANIE LE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 S TELEPHONE RD
MOORE OK
73160-2940
US

IV. Provider business mailing address

2651 S TELEPHONE RD
MOORE OK
73160-2940
US

V. Phone/Fax

Practice location:
  • Phone: 405-300-7671
  • Fax: 405-300-7662
Mailing address:
  • Phone: 405-300-7671
  • Fax: 405-300-7662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21150
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: