Provider Demographics
NPI:1073125167
Name:LE, KHAAI THUY (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:KHAAI
Middle Name:THUY
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265
Mailing Address - Country:US
Mailing Address - Phone:812-346-4834
Mailing Address - Fax:812-346-7058
Practice Address - Street 1:9 N STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265
Practice Address - Country:US
Practice Address - Phone:812-346-4834
Practice Address - Fax:812-346-7058
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019086183500000X
IN26027005A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist