Provider Demographics
NPI:1538405162
Name:LE, KRISTOPHER VAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:VAN
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 1:3109 PAR RD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1262
Mailing Address - Country:US
Mailing Address - Phone:407-716-0202
Mailing Address - Fax:863-385-1378
Practice Address - Street 1:6360 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1225
Practice Address - Country:US
Practice Address - Phone:863-385-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist