MEDICARE: SAMANTHA TAYLOR LEE

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	77757	CA

General Provider Information

NPI Number	:	1568974251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA TAYLOR LEE

Provider Business Mailing Address
First Line	:	967 CLEARFIELD DR
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-2150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4129 18TH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-2407
Country	:	US
Telephone Number	:	415-551-7837
Fax Number	:

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

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	11/02/2017

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