Healthcare Provider Details

I. General information

NPI: 1679416804
Provider Name (Legal Business Name): KENNY LEE PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 DITMARS BLVD
ASTORIA NY
11105-2304
US

IV. Provider business mailing address

4203 247TH ST
LITTLE NECK NY
11363-1642
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-0128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number072985
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: