MEDICARE: DR. JONATHAN VY LE PHARM.D.

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	63564	TX

General Provider Information

NPI Number	:	1528542842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN VY LE PHARM.D.

Provider Business Mailing Address
First Line	:	10831 SHANNON HILLS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-1833
Country	:	US
Telephone Number	:	832-403-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	10831 SHANNON HILLS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77099-1833
Country	:	US
Telephone Number	:	832-403-1919
Fax Number	:

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

Provider Enumeration Date	:	09/21/2018
Last Update Date	:	09/21/2018

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