Healthcare Provider Details

I. General information

NPI: 1811583057
Provider Name (Legal Business Name): EDWARD LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21255 BURBANK BLVD STE 150
WOODLAND HILLS CA
91367-6674
US

IV. Provider business mailing address

21255 BURBANK BLVD STE 150
WOODLAND HILLS CA
91367-6674
US

V. Phone/Fax

Practice location:
  • Phone: 818-592-2440
  • Fax:
Mailing address:
  • Phone: 818-592-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number83954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: