MEDICARE: JENNIE LE DO RPH

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	S014051	AZ

General Provider Information

NPI Number	:	1538498712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIE LE DO RPH

Provider Business Mailing Address
First Line	:	PO BOX 1336
Second Line	:
City	:	LITCHFIELD PARK
State	:	AZ
Zip	:	85340-1336
Country	:	US
Telephone Number	:	623-536-4766
Fax Number	:	623-536-4766

Provider Business Practice Location Address
First Line	:	2626 S 83RD AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-7207
Country	:	US
Telephone Number	:	623-907-2472
Fax Number	:	623-907-0548

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

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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Directions to “ JENNIE LE DO RPH” Practice Location

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