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General NPI Number Information
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NPI Number | 1164713996
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Entity Type | Individual
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Provider Name | TAM THIEN LE PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 6455 PACIFIC AVE
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City | STOCKTON
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State | CA
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Zip | 95207-3715
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Country | US
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Telephone | 209-478-5062
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Fax |
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Provider Business Mailing Address
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Address Line | 3875 VECCHIO LN
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City | STOCKTON
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State | CA
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Zip | 95212-3112
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Country | US
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Telephone | 209-629-3789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 60576
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License Number State | CA
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