Provider Demographics
NPI:1689956351
Name:LE, TRACY NHU (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:NHU
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 1:30015 DATE PALM DR
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-2822
Mailing Address - Country:US
Mailing Address - Phone:760-770-3659
Mailing Address - Fax:760-770-4203
Practice Address - Street 1:30015 DATE PALM DR
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-2822
Practice Address - Country:US
Practice Address - Phone:760-770-3659
Practice Address - Fax:760-770-4203
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist