Healthcare Provider Details

I. General information

NPI: 1770973950
Provider Name (Legal Business Name): EDWARD LEE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 W OLYMPIC BLVD STE 104
LOS ANGELES CA
90006-2800
US

IV. Provider business mailing address

2655 W OLYMPIC BLVD #104
LOS ANGELES CA
90006-2800
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-1503
  • Fax: 213-480-1551
Mailing address:
  • Phone: 213-480-1503
  • Fax: 213-480-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number64512
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: