Provider Demographics
NPI:1033201678
Name:LE, GRACE H (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:H
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2658 NAUTICA CT
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-6300
Mailing Address - Country:US
Mailing Address - Phone:707-624-3328
Mailing Address - Fax:
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:MEDICINE 8
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-4265
Practice Address - Fax:707-651-2821
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist