MEDICARE: DR. GIAO QUYNH 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	PST.018630	LA
2	183500000X	Pharmacist	47281	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124628318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIAO QUYNH LE PHARM.D

Provider Business Mailing Address
First Line	:	4508 SEVENTEEN LAKES CT
Second Line	:
City	:	ROANOKE
State	:	TX
Zip	:	76262-3741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2610 W PIONEER PKWY
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-5904
Country	:	US
Telephone Number	:	817-303-4302
Fax Number	:

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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