Provider Demographics
NPI:1275864241
Name:LE, LOC KHAC (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:LOC
Middle Name:KHAC
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-9700
Mailing Address - Country:US
Mailing Address - Phone:623-907-4932
Mailing Address - Fax:623-907-4990
Practice Address - Street 1:2858 N PINAL AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-7917
Practice Address - Country:US
Practice Address - Phone:520-426-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012817183500000X
AZ1219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist