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General NPI Number Information
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NPI Number | 1083925341
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Entity Type | Individual
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Provider Name | KYOUNG MI LEE
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Gender | Female
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 4220 WHEATON WAY
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City | BREMERTON
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State | WA
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Zip | 98310-3604
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Country | US
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Telephone | 253-509-8810
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Fax |
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Provider Business Mailing Address
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Address Line | 4220 WHEATON WAY
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City | BREMERTON
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State | WA
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Zip | 98310-3604
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Country | US
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Telephone | 253-509-8810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH60077511
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH03329197
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26023085A
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License Number State | IN
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