MEDICARE: DR. LEE ANNA IRLE 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	17028	AL

General Provider Information

NPI Number	:	1396363032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE ANNA IRLE PHARMD

Provider Business Mailing Address
First Line	:	5380 GAMEPOINT DR
Second Line	:
City	:	THEODORE
State	:	AL
Zip	:	36582-7311
Country	:	US
Telephone Number	:	251-604-8664
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SOUTHERN WAY
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36619-1210
Country	:	US
Telephone Number	:	251-544-9500
Fax Number	:

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

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	07/09/2020

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