MEDICARE: DR. TEAK K 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	61718	CA

General Provider Information

NPI Number	:	1871877043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TEAK K LEE PHARM. D.

Provider Business Mailing Address
First Line	:	4940 VAN NUYS BLVD STE 104
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1736
Country	:	US
Telephone Number	:	818-990-3784
Fax Number	:	818-990-1862

Provider Business Practice Location Address
First Line	:	4940 VAN NUYS BLVD STE 104
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1736
Country	:	US
Telephone Number	:	818-990-3784
Fax Number	:	818-990-1862

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

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	12/19/2022

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