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NPI Code Detail

MEDICARE: DESTINY LE

MEDICARE: DESTINY 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
1183500000XPharmacist0010394OR

General Provider Information

NPI Number : 1356697957
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINY LE
Provider Business Mailing Address
First Line : 3527 SE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97236-3401
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3527 SE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97236-3401
Country : US
Telephone Number : 503-760-6688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2012
Last Update Date : 08/01/2012

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Directions to “ DESTINY LE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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