Provider Demographics
NPI:1174927834
Name:CU, LE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LE
Middle Name:
Last Name:CU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 SW 49TH AVE
Mailing Address - Street 2:APT. 133
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5954
Mailing Address - Country:US
Mailing Address - Phone:315-542-1695
Mailing Address - Fax:
Practice Address - Street 1:1600 S WESTERN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-5925
Practice Address - Country:US
Practice Address - Phone:806-463-3062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100560026Medicaid
TX464385Medicaid
AL100560026Medicaid