MEDICARE: JUNG IN LEE PHARMD

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	78880	CA

General Provider Information

NPI Number	:	1306409735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNG IN LEE PHARMD

Provider Business Mailing Address
First Line	:	240 GREGG DR
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-4042
Country	:	US
Telephone Number	:	678-830-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 N 1ST ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95134-1513
Country	:	US
Telephone Number	:	408-434-1839
Fax Number	:

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

Provider Enumeration Date	:	04/22/2019
Last Update Date	:	04/22/2019

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Directions to “ JUNG IN LEE PHARMD” Practice Location

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