MEDICARE: LE VT INC

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	333600000X	Pharmacy	PH27482	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457788010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LE VT INC

Provider Business Mailing Address
First Line	:	4811 SCOTT RD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-4891
Country	:	US
Telephone Number	:	813-486-3043
Fax Number	:	813-443-4789

Provider Business Practice Location Address
First Line	:	11967 SHELDON RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3644
Country	:	US
Telephone Number	:	813-486-3043
Fax Number	:	813-443-4789

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	DR. THUAN H. LE
Credential	:	PHARM D
Telephone Number	:	813-486-3043

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	02/13/2014

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Directions to “LE VT INC ” Practice Location

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