MEDICARE: WAI SHAN 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	183500000X	Pharmacist	86289	CA

General Provider Information

NPI Number	:	1245967736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAI SHAN LEE

Provider Business Mailing Address
First Line	:	3629 NORWICH PL
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-5132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3629 NORWICH PL
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-5132
Country	:	US
Telephone Number	:	626-231-9884
Fax Number	:

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

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/18/2022

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