MEDICARE: LEE FAIRY BEN-DAVID

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	066389	NY

General Provider Information

NPI Number	:	1558022798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE FAIRY BEN-DAVID

Provider Business Mailing Address
First Line	:	6310 108TH ST APT 2J
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1331
Country	:	US
Telephone Number	:	646-750-6673
Fax Number	:

Provider Business Practice Location Address
First Line	:	6310 108TH ST APT 2J
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1331
Country	:	US
Telephone Number	:	646-750-6673
Fax Number	:

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

Provider Enumeration Date	:	01/09/2022
Last Update Date	:	01/09/2022

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Directions to “ LEE FAIRY BEN-DAVID ” Practice Location

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