Provider Demographics
NPI:1386856110
Name:LE, TRI M (PHARMD)
Entity type:Individual
Prefix:MR
First Name:TRI
Middle Name:M
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 1:1916 OAK GROVE CHASE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-2257
Mailing Address - Country:US
Mailing Address - Phone:321-633-8150
Mailing Address - Fax:321-633-6880
Practice Address - Street 1:6257 U.S. HWY 1
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927
Practice Address - Country:US
Practice Address - Phone:321-633-8150
Practice Address - Fax:321-633-6880
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0035050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0035050OtherPHARMACY LICENSE NUMBER