MEDICARE: JOHN WONIL 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	62052	CA

General Provider Information

NPI Number	:	1508152406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WONIL LEE PHARMD

Provider Business Mailing Address
First Line	:	1800 W EMPIRE AVE
Second Line	:	T-1362
City	:	BURBANK
State	:	CA
Zip	:	91504-3403
Country	:	US
Telephone Number	:	818-238-0239
Fax Number	:	818-238-0239

Provider Business Practice Location Address
First Line	:	1800 W EMPIRE AVE
Second Line	:	T-1362
City	:	BURBANK
State	:	CA
Zip	:	91504-3403
Country	:	US
Telephone Number	:	818-238-0239
Fax Number	:	818-238-0239

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

Provider Enumeration Date	:	06/20/2011
Last Update Date	:	06/20/2011

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