Healthcare Provider Details

I. General information

NPI: 1144505280
Provider Name (Legal Business Name): JOHN HENRY LEE JR. R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN HENRY LEE JR. R. PH.

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7433 S CHAPPEL AVE
CHICAGO IL
60649-3619
US

IV. Provider business mailing address

7433 S CHAPPEL AVE
CHICAGO IL
60649-3619
US

V. Phone/Fax

Practice location:
  • Phone: 773-493-1589
  • Fax: 773-493-0019
Mailing address:
  • Phone: 773-493-1589
  • Fax: 773-493-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number051029754
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051029754
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051029754
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: