Healthcare Provider Details

I. General information

NPI: 1275443863
Provider Name (Legal Business Name): GAEUN LEE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W WISCONSIN AVE
APPLETON WI
54914-3511
US

IV. Provider business mailing address

700 W WISCONSIN AVE
APPLETON WI
54914-3511
US

V. Phone/Fax

Practice location:
  • Phone: 920-991-1190
  • Fax:
Mailing address:
  • Phone: 920-991-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2365540
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: