MEDICARE: JEFFREY D LEE PHARM D

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	57904	CA

General Provider Information

NPI Number	:	1548526429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY D LEE PHARM D

Provider Business Mailing Address
First Line	:	159 N GLENDORA AVE
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-3342
Country	:	US
Telephone Number	:	626-335-0221
Fax Number	:	626-335-2913

Provider Business Practice Location Address
First Line	:	159 N GLENDORA AVE
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-3342
Country	:	US
Telephone Number	:	626-335-0221
Fax Number	:	626-335-2913

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

Provider Enumeration Date	:	04/05/2012
Last Update Date	:	04/05/2012

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