Provider Demographics
NPI:1235626177
Name:LE, HARRY (PHARMD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:HA
Other - Middle Name:BA
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1006 N HOME PL
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3133
Mailing Address - Country:US
Mailing Address - Phone:714-331-4268
Mailing Address - Fax:
Practice Address - Street 1:167 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045
Practice Address - Country:US
Practice Address - Phone:928-283-2754
Practice Address - Fax:928-283-1433
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist