Healthcare Provider Details

I. General information

NPI: 1902149529
Provider Name (Legal Business Name): MAI VU LE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

IV. Provider business mailing address

3908 LARO CT
FAIRFAX VA
22031-3256
US

V. Phone/Fax

Practice location:
  • Phone: 703-287-4664
  • Fax:
Mailing address:
  • Phone: 703-425-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202007285
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: