Provider Demographics
NPI:1750600284
Name:LE, UT THI (DOCTORATE)
Entity type:Individual
Prefix:
First Name:UT
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SAN PEDRO DR SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3009
Mailing Address - Country:US
Mailing Address - Phone:505-268-2411
Mailing Address - Fax:505-268-2654
Practice Address - Street 1:201 SAN PEDRO DR SE
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3009
Practice Address - Country:US
Practice Address - Phone:505-268-2411
Practice Address - Fax:505-268-2654
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000068321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist