Provider Demographics
NPI:1528642436
Name:LE, VIVIAN (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 WEST ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-3825
Mailing Address - Country:US
Mailing Address - Phone:617-686-6603
Mailing Address - Fax:781-843-1675
Practice Address - Street 1:178 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-1708
Practice Address - Country:US
Practice Address - Phone:781-843-0731
Practice Address - Fax:781-843-1675
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist