MEDICARE: GAVIN LEE PHARMD

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	56644	CA

General Provider Information

NPI Number	:	1265855753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAVIN LEE PHARMD

Provider Business Mailing Address
First Line	:	30019 HAWTHORNE BLVD
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90275-5434
Country	:	US
Telephone Number	:	310-377-6829
Fax Number	:

Provider Business Practice Location Address
First Line	:	30019 HAWTHORNE BLVD
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90275-5434
Country	:	US
Telephone Number	:	310-377-6829
Fax Number	:

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

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	02/04/2014

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