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NPI Code Detail

MEDICARE: GRACE LEE PHARM. D.

MEDICARE: GRACE 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
1183500000XPharmacist52326CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1183500000XOTHERCATAXONOMY

General Provider Information

NPI Number : 1861705881
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE LEE PHARM. D.
Provider Business Mailing Address
First Line : 1433 GLENDALE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-2428
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1433 GLENDALE BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-2428
Country : US
Telephone Number : 213-483-8450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2010
Last Update Date : 07/19/2010

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