Healthcare Provider Details

I. General information

NPI: 1326959776
Provider Name (Legal Business Name): JUNGSEOK LEE PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 STATE BRIDGE RD
ALPHARETTA GA
30022-4471
US

IV. Provider business mailing address

2370 MAIN ST NW APT 1414
DULUTH GA
30097-2851
US

V. Phone/Fax

Practice location:
  • Phone: 770-751-7991
  • Fax:
Mailing address:
  • Phone: 770-952-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036520
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: