Provider Demographics
NPI:1871124842
Name:LE, EMILY ALYSSA (PHARMD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ALYSSA
Last Name:LE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ALYSSA
Other - Last Name:QUAST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:715 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-2560
Mailing Address - Country:US
Mailing Address - Phone:716-572-8816
Mailing Address - Fax:
Practice Address - Street 1:214 LOCKPORT ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:NY
Practice Address - Zip Code:14174-1008
Practice Address - Country:US
Practice Address - Phone:716-745-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03438460183500000X
NY065478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist