MEDICARE: DR. MYDUNG TRAN LE PHARM. D

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	46564	TX

General Provider Information

NPI Number	:	1063740413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYDUNG TRAN LE PHARM. D

Provider Business Mailing Address
First Line	:	1301 EAST NASA PARKWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	281-990-8024
Fax Number	:	281-486-0185

Provider Business Practice Location Address
First Line	:	1301 NASA PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3112
Country	:	US
Telephone Number	:	281-990-8024
Fax Number	:	281-486-0185

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

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	11/23/2009

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