Healthcare Provider Details

I. General information

NPI: 1306864632
Provider Name (Legal Business Name): LISA SUNG EUN LEE PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ALDEN DRIVE
FE WARREN AFB WY
82005
US

IV. Provider business mailing address

6900 ALDEN DRIVE
FE WARREN AFB WY
82005
US

V. Phone/Fax

Practice location:
  • Phone: 307-773-6248
  • Fax: 307-773-4589
Mailing address:
  • Phone: 307-773-6248
  • Fax: 307-773-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02871300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: