=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396847158
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMIE W LEE PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2006
-----------------------------------------------------
Last Update Date | 07/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | VA LOMA LINDA HEALTH CARE SYTEM # 119 11201 BENTON ST
-----------------------------------------------------
City | LOMA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92357-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-825-7084
-----------------------------------------------------
Fax | 909-777-3263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | VA LOMA LINDA HEALTH CARE SYTEM # 119 11201 BENTON ST
-----------------------------------------------------
City | LOMA LINDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92357-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-825-7084
-----------------------------------------------------
Fax | 909-777-3263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1300X
-----------------------------------------------------
Taxonomy Name | Psychiatric Pharmacist
-----------------------------------------------------
License Number | 46738
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------