MEDICARE: DR. RONALD 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	051.293147	IL

General Provider Information

NPI Number	:	1649551490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD LEE PHARM.D.

Provider Business Mailing Address
First Line	:	1627 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-5207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1627 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-5207
Country	:	US
Telephone Number	:	773-772-5432
Fax Number	:

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

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	02/12/2014

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