Healthcare Provider Details

I. General information

NPI: 1043655830
Provider Name (Legal Business Name): JANE SIM LEE PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16145 SIERRA LAKES PKWY
FONTANA CA
92336-1243
US

IV. Provider business mailing address

426 BREA HILLS AVE
BREA CA
92823-1800
US

V. Phone/Fax

Practice location:
  • Phone: 909-356-9167
  • Fax:
Mailing address:
  • Phone: 925-989-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55404
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: