Provider Demographics
NPI:1770879272
Name:LE, KHANH QUOC (PHARMD)
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:QUOC
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 S STATE HIGHWAY 360
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8307
Mailing Address - Country:US
Mailing Address - Phone:469-348-2101
Mailing Address - Fax:469-348-2104
Practice Address - Street 1:5270 S STATE HIGHWAY 360
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8307
Practice Address - Country:US
Practice Address - Phone:469-348-2101
Practice Address - Fax:469-348-2104
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist