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NPI Code Detail

MEDICARE: LEE DAVID KOHLER

MEDICARE: LEE DAVID KOHLER
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
1183500000XPharmacist2024040264MO

General Provider Information

NPI Number : 1629898127
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEE DAVID KOHLER
Provider Business Mailing Address
First Line : 8640 COMMERCIAL BLVD
Second Line :
City : PEVELY
State : MO
Zip : 63070-1529
Country : US
Telephone Number : 636-479-6100
Fax Number : 636-479-6101
Provider Business Practice Location Address
First Line : 7922 MACKENZIE RD
Second Line :
City : AFFTON
State : MO
Zip : 63123-2721
Country : US
Telephone Number : 314-638-3535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2024
Last Update Date : 10/10/2024

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