MEDICARE: REBECCA L 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	26018980A	IN

General Provider Information

NPI Number	:	1679867568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L LEE PHARM.D

Provider Business Mailing Address
First Line	:	6119 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5357
Country	:	US
Telephone Number	:	260-485-4697
Fax Number	:	260-485-4697

Provider Business Practice Location Address
First Line	:	6119 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5357
Country	:	US
Telephone Number	:	260-485-4697
Fax Number	:	260-485-4697

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

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	06/08/2011

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