Provider Demographics
NPI:1770684953
Name:LEE, MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 N MILWAUKEE AVE
Mailing Address - Street 2:ALBANY PHARMACY
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1735
Mailing Address - Country:US
Mailing Address - Phone:847-699-1500
Mailing Address - Fax:847-699-1515
Practice Address - Street 1:8850 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1735
Practice Address - Country:US
Practice Address - Phone:847-699-1500
Practice Address - Fax:847-699-1515
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36371239001Medicaid