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1215063979 NPI number — MATTHEW ALAN LEE PHARMD

NPI Number: 1215063979
Health Care Provider/Practitioner: MATTHEW ALAN LEE PHARMD

Information about “1215063979” NPI (MATTHEW ALAN LEE PHARMD) exists in 1215063979 in HTML format HTML  |  1215063979 in plain Text format TXT  |  1215063979 in PDF (Portable Document Format) PDF  |  1215063979 in an XML format XML  formats.

NPI Number : 1215063979 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215063979",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEE",
    "FirstName": "MATTHEW",
    "MiddleName": "ALAN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4553 N MAGNOLIA AVE",
    "SecondLineMailingAddress": "UNIT #504",
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60640-3059",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "773-334-4688",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5510 HOWARD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SKOKIE",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60077-2620",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-588-7466",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/26/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "51289042",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "RP046043L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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