MEDICARE: KENNETH D 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	RP045104L	PA

General Provider Information

NPI Number	:	1720673197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH D LEE PHARMACIST

Provider Business Mailing Address
First Line	:	8545 NEW FALLS RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19054-1601
Country	:	US
Telephone Number	:	215-547-2378
Fax Number	:

Provider Business Practice Location Address
First Line	:	8545 NEW FALLS RD
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19054-1601
Country	:	US
Telephone Number	:	215-547-2378
Fax Number	:

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

Provider Enumeration Date	:	03/07/2021
Last Update Date	:	03/07/2021

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