MEDICARE: MARK 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	0598181	NY
2	183500000X	Pharmacist	28R103672400	NJ

General Provider Information

NPI Number	:	1629466032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK LEE

Provider Business Mailing Address
First Line	:	100 FOREST ST
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-1619
Country	:	US
Telephone Number	:	201-906-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 FOREST ST
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-1619
Country	:	US
Telephone Number	:	201-906-8258
Fax Number	:

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

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	01/07/2015

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Directions to “ MARK LEE ” Practice Location

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