Provider Demographics
NPI:1639479959
Name:LE, BRIAN IV (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LE
Suffix:IV
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-5721
Mailing Address - Country:US
Mailing Address - Phone:253-852-5115
Mailing Address - Fax:253-850-1051
Practice Address - Street 1:210 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5721
Practice Address - Country:US
Practice Address - Phone:253-852-5115
Practice Address - Fax:253-850-1051
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60093196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist