=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033104872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE VEVECKA LEE PHARM.D., CLS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2005
-----------------------------------------------------
Last Update Date | 08/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6025 VIA MADRID
-----------------------------------------------------
City | GRANITE BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95746-5802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-773-7227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6025 VIA MADRID ST
-----------------------------------------------------
City | GRANITE BAY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-773-7227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 53344
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------