MEDICARE: KENNY LEE PHARMACIST

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	072985	NY

General Provider Information

NPI Number	:	1679416804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNY LEE PHARMACIST

Provider Business Mailing Address
First Line	:	4203 247TH ST
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11363-1642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9015 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7938
Country	:	US
Telephone Number	:	718-429-7666
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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