Provider Demographics
NPI:1497956221
Name:LE, VICKIE H (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:H
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3015
Mailing Address - Country:US
Mailing Address - Phone:909-983-4638
Mailing Address - Fax:909-391-2482
Practice Address - Street 1:1841 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-2601
Practice Address - Country:US
Practice Address - Phone:909-983-8202
Practice Address - Fax:909-391-2482
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist