MEDICARE: JOHN C LEE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP444193	PA

General Provider Information

NPI Number	:	1033424288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C LEE PHARMD

Provider Business Mailing Address
First Line	:	4 CREEK PKWY
Second Line	:	SUITE A
City	:	UPPER CHICHESTER
State	:	PA
Zip	:	19061-3132
Country	:	US
Telephone Number	:	800-223-4376
Fax Number	:	800-355-1029

Provider Business Practice Location Address
First Line	:	4 CREEK PKWY
Second Line	:	SUITE A
City	:	UPPER CHICHESTER
State	:	PA
Zip	:	19061-3132
Country	:	US
Telephone Number	:	800-223-4376
Fax Number	:	800-355-1029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2010
Last Update Date	:	02/01/2013

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