Provider Demographics
NPI:1164008934
Name:LE, MARTIN HIEN
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:HIEN
Last Name:LE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 PURSER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-2935
Mailing Address - Country:US
Mailing Address - Phone:803-931-2801
Mailing Address - Fax:
Practice Address - Street 1:1600 PURSER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-2935
Practice Address - Country:US
Practice Address - Phone:980-207-3267
Practice Address - Fax:980-207-3268
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist