Healthcare Provider Details

I. General information

NPI: 1326671611
Provider Name (Legal Business Name): JAEJUN LEE PHARMD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2020
Last Update Date: 02/15/2020
Certification Date: 02/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WENDELL ST
PLAINVIEW NY
11803-4629
US

IV. Provider business mailing address

33 WENDELL ST
PLAINVIEW NY
11803-4629
US

V. Phone/Fax

Practice location:
  • Phone: 516-884-4555
  • Fax:
Mailing address:
  • Phone: 516-884-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number066520
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: