Healthcare Provider Details

I. General information

NPI: 1497218697
Provider Name (Legal Business Name): MRS. LINH MY LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2019
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 DOOLITTLE AVE
FORT WORTH TX
76127-1133
US

IV. Provider business mailing address

2829 WHITE ROCK DR
FORT WORTH TX
76131-2052
US

V. Phone/Fax

Practice location:
  • Phone: 817-782-5929
  • Fax:
Mailing address:
  • Phone: 817-793-3169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51947
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: