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General NPI Number Information
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NPI Number | 1033303177
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Entity Type | Organization
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Legal Business Name | TWELVE BRIDGES PHARMACY, INC.
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Dates
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Enumeration Date | 08/31/2007
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Last Update Date | 09/12/2008
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Provider Practice Location Address
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Address Line | 835 TWELVE BRIDGES DRIVE SUITE 82
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City | LINCOLN
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State | CA
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Zip | 95648-8817
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Country | US
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Telephone | 916-409-9500
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Fax | 916-409-9400
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Provider Business Mailing Address
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Address Line | 835 TWELVE BRIDGES DRIVE SUITE 82
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City | LINCOLN
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State | CA
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Zip | 95648-8817
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Country | US
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Telephone | 916-409-9500
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Fax | 916-409-9400
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HUYQUANG CHI LE
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Credential | PHARM.D
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Telephone | 916-415-0722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY48802
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License Number State | CA
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