Healthcare Provider Details

I. General information

NPI: 1639093578
Provider Name (Legal Business Name): JOAN LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WHITE ST
CAMBRIDGE MA
02140-1442
US

IV. Provider business mailing address

270 PLEASANT ST APT 220
WATERTOWN MA
02472-2475
US

V. Phone/Fax

Practice location:
  • Phone: 617-876-5519
  • Fax:
Mailing address:
  • Phone: 508-873-5896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH241325
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: