Healthcare Provider Details

I. General information

NPI: 1700970175
Provider Name (Legal Business Name): RICKY L LEE PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2486
  • Fax: 650-742-2632
Mailing address:
  • Phone: 650-742-2486
  • Fax: 650-742-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: