Provider Demographics
NPI:1760892525
Name:LE, DAT (RPH)
Entity Type:Individual
Prefix:
First Name:DAT
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11726 RIDGE RUN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-6133
Mailing Address - Country:US
Mailing Address - Phone:858-610-7501
Mailing Address - Fax:
Practice Address - Street 1:11726 RIDGE RUN WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-6133
Practice Address - Country:US
Practice Address - Phone:858-610-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47837OtherCALIFORNIA BOARD OF PHARMACY