MEDICARE: KRISTEN CHARITY 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	PS53128	FL

General Provider Information

NPI Number	:	1235789736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN CHARITY LEE PHARMD

Provider Business Mailing Address
First Line	:	2163 POST ST APT 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3725
Country	:	US
Telephone Number	:	386-690-9770
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 W 8TH ST # C23
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-844-7973
Fax Number	:

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

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	09/17/2019

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