Provider Demographics
NPI:1083057699
Name:LE, BICH-VY THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:BICH-VY
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:VY
Other - Middle Name:BICH
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1610 S RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-7708
Mailing Address - Country:US
Mailing Address - Phone:909-820-7635
Mailing Address - Fax:
Practice Address - Street 1:1610 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7708
Practice Address - Country:US
Practice Address - Phone:909-820-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18862183500000X
CA65150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist