MEDICARE: DR. MARSHALL 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	051.302482	IL

General Provider Information

NPI Number	:	1437755295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARSHALL LEE PHARMD

Provider Business Mailing Address
First Line	:	3680 WASHINGTON AVE APT C
Second Line	:
City	:	GREAT LAKES
State	:	IL
Zip	:	60088-1737
Country	:	US
Telephone Number	:	612-759-9260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 WASHINGTON AVE APT C
Second Line	:
City	:	GREAT LAKES
State	:	IL
Zip	:	60088-1737
Country	:	US
Telephone Number	:	612-759-9260
Fax Number	:

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

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	05/07/2026

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