Provider Demographics
NPI:1184226326
Name:LE, TRI MINH (RPH, PHARMD)
Entity Type:Individual
Prefix:MR
First Name:TRI
Middle Name:MINH
Last Name:LE
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 N NARCISSUS CT
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1750
Mailing Address - Country:US
Mailing Address - Phone:405-659-5902
Mailing Address - Fax:
Practice Address - Street 1:1300 E ALBANY ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8951
Practice Address - Country:US
Practice Address - Phone:918-505-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist