Provider Demographics
NPI:1679871503
Name:LE, XUYEN KIM (RPH)
Entity Type:Individual
Prefix:
First Name:XUYEN
Middle Name:KIM
Last Name:LE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MOUNTAIN LAKE DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7721
Mailing Address - Country:US
Mailing Address - Phone:678-427-5692
Mailing Address - Fax:770-529-0711
Practice Address - Street 1:3245 COBB PKWY NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-3938
Practice Address - Country:US
Practice Address - Phone:770-974-0936
Practice Address - Fax:770-529-0711
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist