Healthcare Provider Details

I. General information

NPI: 1033104872
Provider Name (Legal Business Name): CHRISTINE VEVECKA LEE PHARM.D., CLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 VIA MADRID
GRANITE BAY CA
95746-5802
US

IV. Provider business mailing address

6025 VIA MADRID ST
GRANITE BAY CA
95746
US

V. Phone/Fax

Practice location:
  • Phone: 916-773-7227
  • Fax:
Mailing address:
  • Phone: 916-773-7227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: