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General NPI Number Information
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NPI Number | 1366738718
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Entity Type | Individual
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Provider Name | RICK D. LEE
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Gender | Male
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 7100 W STATE ST
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City | BOISE
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State | ID
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Zip | 83714-7497
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Country | US
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Telephone | 208-841-1160
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Fax | 208-336-6424
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Provider Business Mailing Address
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Address Line | 4038 W QUAIL RIDGE DR
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City | BOISE
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State | ID
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Zip | 83703-3850
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Country | US
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Telephone | 208-343-2687
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Fax | 208-343-2687
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | P3646
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License Number State | ID
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