MEDICARE: LISA 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	21774	MD

General Provider Information

NPI Number	:	1316352503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LE

Provider Business Mailing Address
First Line	:	7118 INTREPID LN
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20879-5418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 OLNEY SANDY SPRING RD
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-1408
Country	:	US
Telephone Number	:	301-774-6155
Fax Number	:

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

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	06/25/2014

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Directions to “ LISA LE ” Practice Location

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