Provider Demographics
NPI:1326322900
Name:LE, TUAN
Entity Type:Individual
Prefix:
First Name:TUAN
Middle Name:
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 1:3900 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3414
Mailing Address - Country:US
Mailing Address - Phone:314-875-0121
Mailing Address - Fax:
Practice Address - Street 1:3900 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3414
Practice Address - Country:US
Practice Address - Phone:314-875-0121
Practice Address - Fax:314-875-0203
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist