=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437510666
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS LEE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2016
-----------------------------------------------------
Last Update Date | 03/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1377 HYDE PARK AVE
-----------------------------------------------------
City | HYDE PARK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02136-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-364-3161
-----------------------------------------------------
Fax | 617-361-3417
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1377 HYDE PARK AVE
-----------------------------------------------------
City | HYDE PARK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02136-2752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-364-3161
-----------------------------------------------------
Fax | 617-361-3417
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 24188
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------