MEDICARE: LIEN KIM LE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	59162	TX

General Provider Information

NPI Number	:	1013506252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIEN KIM LE

Provider Business Mailing Address
First Line	:	6016 CEDAR GLEN CT
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-0410
Country	:	US
Telephone Number	:	214-909-6519
Fax Number	:

Provider Business Practice Location Address
First Line	:	3851 AIRPORT FWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-5906
Country	:	US
Telephone Number	:	817-759-1926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	01/12/2021

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Directions to “ LIEN KIM LE ” Practice Location

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