MEDICARE: MR. LEE OVERSTREET R.PH.

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	26024948A	IN
2	183500000X	Pharmacist	2713	WY
3	183500000X	Pharmacist	011954	KY

General Provider Information

NPI Number	:	1790109858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEE OVERSTREET R.PH.

Provider Business Mailing Address
First Line	:	1702 E SPRING ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-1652
Country	:	US
Telephone Number	:	812-949-5015
Fax Number	:	812-949-7363

Provider Business Practice Location Address
First Line	:	1702 E SPRING ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-1652
Country	:	US
Telephone Number	:	812-949-5015
Fax Number	:	812-949-7363

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

Provider Enumeration Date	:	02/10/2014
Last Update Date	:	02/10/2014

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