MEDICARE: LECARE PHARMACY LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1912534926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LECARE PHARMACY LLC

Provider Business Mailing Address
First Line	:	1619 NE 42ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-6968
Country	:	US
Telephone Number	:	971-358-6888
Fax Number	:	971-358-6889

Provider Business Practice Location Address
First Line	:	1619 NE 42ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97213-1524
Country	:	US
Telephone Number	:	503-332-0778
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST/OWNER
Name	:	SANDY TUYET XUAN LE
Credential	:
Telephone Number	:	503-332-0778

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	10/19/2020

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