Provider Demographics
NPI:1780757914
Name:LEE, MELANIE C (RPH)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:C
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3757 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5712
Mailing Address - Country:US
Mailing Address - Phone:773-539-1234
Mailing Address - Fax:773-539-1122
Practice Address - Street 1:3757 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5712
Practice Address - Country:US
Practice Address - Phone:773-539-1234
Practice Address - Fax:773-539-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363193228001Medicaid