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NPI Code Detail

MEDICARE: JAMIE LEE

MEDICARE: JAMIE 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
11835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist013874KY

General Provider Information

NPI Number : 1629693825
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE LEE
Provider Business Mailing Address
First Line : 706 N ARBOR DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-2360
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11401 BLUEGRASS PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-2349
Country : US
Telephone Number : 866-501-3997
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2020
Last Update Date : 06/12/2020

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