MEDICARE: CHRISTINE 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	055143	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	055143	OTHER	NY	PHARMACIST

General Provider Information

NPI Number	:	1699072496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE LEE

Provider Business Mailing Address
First Line	:	5218 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5218 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2816
Country	:	US
Telephone Number	:	917-790-9412
Fax Number	:

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

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/15/2011

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