Provider Demographics
NPI:1528542842
Name:LE, JONATHAN VY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:VY
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 1:10831 SHANNON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-1833
Mailing Address - Country:US
Mailing Address - Phone:832-403-1919
Mailing Address - Fax:
Practice Address - Street 1:10831 SHANNON HILLS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-1833
Practice Address - Country:US
Practice Address - Phone:832-403-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist