MEDICARE: DIANE LEE

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	56381	TX

General Provider Information

NPI Number	:	1295181238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE LEE

Provider Business Mailing Address
First Line	:	5630 N DESERT BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5630 N DESERT BLVD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1636
Country	:	US
Telephone Number	:	915-845-1422
Fax Number	:

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

Provider Enumeration Date	:	05/09/2016
Last Update Date	:	05/09/2016

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Directions to “ DIANE LEE ” Practice Location

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