Provider Demographics
NPI:1730597410
Name:LE, MICHAEL N (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:N
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 1:3615 CRATER LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9259
Mailing Address - Country:US
Mailing Address - Phone:541-227-5403
Mailing Address - Fax:541-227-5397
Practice Address - Street 1:3615 CRATER LAKE HWY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9259
Practice Address - Country:US
Practice Address - Phone:541-227-5403
Practice Address - Fax:541-227-5397
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010126183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist