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NPI Code Detail

MEDICARE: MICHELLE LEE

MEDICARE: MICHELLE 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
1183500000XPharmacistRPH015764GA

General Provider Information

NPI Number : 1700487857
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE LEE
Provider Business Mailing Address
First Line : 355 ALCOVY CIR
Second Line :
City : COVINGTON
State : GA
Zip : 30014-4924
Country : US
Telephone Number : 678-591-0772
Fax Number :
Provider Business Practice Location Address
First Line : 201 WALMART DR
Second Line :
City : EATONTON
State : GA
Zip : 31024-6761
Country : US
Telephone Number : 706-485-4536
Fax Number : 706-485-4398
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2020
Last Update Date : 11/05/2020

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Directions to “ MICHELLE LEE ” Practice Location

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