Provider Demographics
NPI:1306568134
Name:LE, COLBY DUC KHANH (RPH)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:DUC KHANH
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 1:4229 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-4811
Mailing Address - Country:US
Mailing Address - Phone:405-694-1796
Mailing Address - Fax:
Practice Address - Street 1:4420 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3414
Practice Address - Country:US
Practice Address - Phone:405-632-3742
Practice Address - Fax:405-632-6730
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist