MEDICARE: MR. ROBERT LEE R.PH.

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	03122506	OH

General Provider Information

NPI Number	:	1245485747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LEE R.PH.

Provider Business Mailing Address
First Line	:	6400 OAKES RD
Second Line	:
City	:	BRECKSVILLE
State	:	OH
Zip	:	44141-2639
Country	:	US
Telephone Number	:	503-332-5454
Fax Number	:	216-635-4500

Provider Business Practice Location Address
First Line	:	5500 LANCASTER DR
Second Line	:
City	:	BROOKLYN HEIGHTS
State	:	OH
Zip	:	44131-1834
Country	:	US
Telephone Number	:	216-524-5003
Fax Number	:	216-635-4500

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

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	11/25/2008

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