Provider Demographics
NPI:1255001889
Name:LE, THAO MAI (RPH)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:MAI
Last Name:LE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21301 S TAMIAMI TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-2943
Mailing Address - Country:US
Mailing Address - Phone:239-948-1182
Mailing Address - Fax:
Practice Address - Street 1:21301 S TAMIAMI TRL STE 200
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-2943
Practice Address - Country:US
Practice Address - Phone:239-948-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist