Provider Demographics
NPI:1134252976
Name:LE, THU-THAO THI (RPH)
Entity type:Individual
Prefix:MRS
First Name:THU-THAO
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:MELANIE THU-THAO
Other - Middle Name:T
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:4547 8TH AVE NE #608
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6717
Mailing Address - Country:US
Mailing Address - Phone:206-200-7350
Mailing Address - Fax:866-372-9676
Practice Address - Street 1:120 106TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5910
Practice Address - Country:US
Practice Address - Phone:206-200-7350
Practice Address - Fax:866-372-9676
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2013-12-06
Deactivation Date:2009-03-04
Deactivation Code:
Reactivation Date:2012-09-26
Provider Licenses
StateLicense IDTaxonomies
WA48935333600000X
WAPH48935333600000X
WAPH-00048935333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy