Provider Demographics
NPI:1548419500
Name:LE, TUYETLAN THI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TUYETLAN
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LAN
Other - Middle Name:TUYET
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9316 54TH CT E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-5435
Mailing Address - Country:US
Mailing Address - Phone:941-776-3715
Mailing Address - Fax:
Practice Address - Street 1:5945 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-2953
Practice Address - Country:US
Practice Address - Phone:941-722-2884
Practice Address - Fax:941-723-3654
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist