MEDICARE: MR. JOHN LEE R. PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH22347	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0524719	OTHER	CA	NCPDP NUMBER

General Provider Information

NPI Number	:	1063402089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN LEE R. PH.

Provider Business Mailing Address
First Line	:	2191 NILES ST
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93305-5007
Country	:	US
Telephone Number	:	661-327-4248
Fax Number	:	661-327-1025

Provider Business Practice Location Address
First Line	:	2191 NILES ST
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93305-5007
Country	:	US
Telephone Number	:	661-327-4248
Fax Number	:	661-327-1025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	03/12/2024

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Directions to “ MR. JOHN LEE R. PH.” Practice Location

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