Healthcare Provider Details

I. General information

NPI: 1932028677
Provider Name (Legal Business Name): LEE MEREDITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36500 AURORA DR
SUMMIT WI
53066-4899
US

IV. Provider business mailing address

W297S3217 BOETTCHER RD
WAUKESHA WI
53189-8938
US

V. Phone/Fax

Practice location:
  • Phone: 262-434-8837
  • Fax:
Mailing address:
  • Phone: 262-490-9215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1756740
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: