MEDICARE: SAMUEL SHIK LEE

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	26020597A	IN

General Provider Information

NPI Number	:	1942913660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL SHIK LEE

Provider Business Mailing Address
First Line	:	706 N ARBOR DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-2360
Country	:	US
Telephone Number	:	502-558-1174
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 LOGISTICS AVE STE B
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-4672
Country	:	US
Telephone Number	:	812-850-2253
Fax Number	:

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

Provider Enumeration Date	:	12/27/2022
Last Update Date	:	12/27/2022

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