MEDICARE: MS. VANESSA E. LEE PHARM. D.

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	052637	NY

General Provider Information

NPI Number	:	1568786952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VANESSA E. LEE PHARM. D.

Provider Business Mailing Address
First Line	:	139 FLATBUSH AVE
Second Line	:	T-1849
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1450
Country	:	US
Telephone Number	:	718-290-1110
Fax Number	:	718-290-1110

Provider Business Practice Location Address
First Line	:	139 FLATBUSH AVE
Second Line	:	T-1849
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1450
Country	:	US
Telephone Number	:	718-290-1110
Fax Number	:	718-290-1110

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

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	03/15/2010

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