MEDICARE: ELISSA LEE PHARMD

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	PH1000894	MA

General Provider Information

NPI Number	:	1942191754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA LEE PHARMD

Provider Business Mailing Address
First Line	:	468 BLUE HILL AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02121-4308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	468 BLUE HILL AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02121-4308
Country	:	US
Telephone Number	:	617-427-7806
Fax Number	:

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

Provider Enumeration Date	:	07/10/2025
Last Update Date	:	12/05/2025

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Directions to “ ELISSA LEE PHARMD” Practice Location

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