MEDICARE: MICHAEL LEE RPH

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	051033133	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770684953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL LEE RPH

Provider Business Mailing Address
First Line	:	8850 N MILWAUKEE AVE
Second Line	:	ALBANY PHARMACY
City	:	NILES
State	:	IL
Zip	:	60714-1735
Country	:	US
Telephone Number	:	847-699-1500
Fax Number	:	847-699-1515

Provider Business Practice Location Address
First Line	:	8850 N MILWAUKEE AVE
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-1735
Country	:	US
Telephone Number	:	847-699-1500
Fax Number	:	847-699-1515

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	12/19/2011

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