Provider Demographics
NPI:1750628921
Name:LE, SANDY XUAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:XUAN
Last Name:LE
Suffix:
Gender:F
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 1:1619 NE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1345
Mailing Address - Country:US
Mailing Address - Phone:971-358-6888
Mailing Address - Fax:971-358-6889
Practice Address - Street 1:1619 NE 42ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2101
Practice Address - Country:US
Practice Address - Phone:503-332-0778
Practice Address - Fax:503-332-0778
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10300183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist