MEDICARE: AUDREY LEE

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	1835P1200X	Pharmacotherapy Pharmacist	45897	CA

General Provider Information

NPI Number	:	1164520722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY LEE

Provider Business Mailing Address
First Line	:	170 SAN PABLO AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94127-1536
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	170 SAN PABLO AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94127-1536
Country	:	US
Telephone Number	:	415-664-8887
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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Directions to “ AUDREY LEE ” Practice Location

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