MEDICARE: TINA 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	70990	CA

General Provider Information

NPI Number	:	1790242642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA LE

Provider Business Mailing Address
First Line	:	1063 C ST
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1700
Country	:	US
Telephone Number	:	209-745-9534
Fax Number	:

Provider Business Practice Location Address
First Line	:	1063 C ST
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1700
Country	:	US
Telephone Number	:	209-745-9534
Fax Number	:

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

Provider Enumeration Date	:	02/27/2019
Last Update Date	:	02/27/2019

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Directions to “ TINA LE ” Practice Location

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