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General NPI Number Information
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NPI Number | 1154529758
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Entity Type | Individual
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Provider Name | SUNG IL LEE PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2173 PICKWICK DR
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City | CAMARILLO
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State | CA
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Zip | 93010-6426
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Country | US
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Telephone | 805-389-5311
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Fax | 805-389-5309
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Provider Business Mailing Address
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Address Line | 11542 DECENTE DR
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City | STUDIO CITY
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State | CA
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Zip | 91604-3868
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Country | US
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Telephone | 818-766-3413
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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 | RPH29930
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License Number State | CA
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