MEDICARE: PHUONG CHI NAM LE PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	125307	MN

General Provider Information

NPI Number	:	1194446856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUONG CHI NAM LE PHARMD

Provider Business Mailing Address
First Line	:	929 PORTLAND AVE
Second Line	:	SUITE 1706
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1266
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	929 PORTLAND AVE
Second Line	:	SUITE 1706
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1266
Country	:	US
Telephone Number	:	612-471-6596
Fax Number	:

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

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	09/09/2022

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