Active NPI
Kenneth Lee
- Pharmacist
- Dallas, TX
National Provider Identifier
1154926731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 64579
- Practice address
- 3012 Mockingbird LN
Dallas, TX 75205-2323 - Phone
- (256) 468-5589
- NPI assigned
- Dec 2, 2020
- Last updated
- Dec 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 64579 | TX | Primary |
Addresses
Primary practice location
3012 Mockingbird LN
Dallas, TX 75205-2323
Mailing address
3012 Mockingbird LN
Dallas, TX 75205-2323
Phone (214) 363-5525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64579 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CVS Pharmacy Inc | Past | Accepting new patients | |
| CVS Pharmacy Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606867200000",
"number": "1154926731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3012 MOCKINGBIRD LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752052323",
"telephone_number": "214-363-5525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3012 MOCKINGBIRD LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752052323",
"telephone_number": "256-468-5589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KENNETH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-02",
"last_updated": "2020-12-02",
"certification_date": "2020-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "64579",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.