MEDICARE: MRS. KIMTHOA THI LE PHARMACIST

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	35176	TX

General Provider Information

NPI Number	:	1205836681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMTHOA THI LE PHARMACIST

Provider Business Mailing Address
First Line	:	4755 ALDINE MAIL ROUTE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77039-5934
Country	:	US
Telephone Number	:	281-985-7647
Fax Number	:	281-985-7796

Provider Business Practice Location Address
First Line	:	4755 ALDINE MAIL ROUTE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77039-5934
Country	:	US
Telephone Number	:	281-985-7647
Fax Number	:	281-985-7796

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	08/28/2007

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