Provider Demographics
NPI:1134482144
Name:LE, ALEXIS H
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:H
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N WILLOW STREET PIKE
Mailing Address - Street 2:KMART PHARMACY #3810
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 N WILLOW STREET PIKE
Practice Address - Street 2:KMART PHARMACY #3810
Practice Address - City:WILLOW STREET
Practice Address - State:PA
Practice Address - Zip Code:17584
Practice Address - Country:US
Practice Address - Phone:717-464-4399
Practice Address - Fax:717-464-1734
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP042453L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist