MEDICARE: NHI THI MINH 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	89630	CA

General Provider Information

NPI Number	:	1376266320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NHI THI MINH LE

Provider Business Mailing Address
First Line	:	10211 RUDDER WAY
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-4346
Country	:	US
Telephone Number	:	209-923-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 BROADWAY
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611
Country	:	US
Telephone Number	:	209-923-3711
Fax Number	:

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

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	09/23/2022

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