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General NPI Number Information
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NPI Number | 1184434854
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Entity Type | Individual
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Provider Name | JAEYEON LEE
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Gender | Male
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 500 S PIONEER WAY
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City | MOSES LAKE
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State | WA
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Zip | 98837-1812
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Country | US
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Telephone | 509-765-1219
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S DIVISION ST APT 6
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City | MOSES LAKE
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State | WA
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Zip | 98837-3822
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Country | US
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Telephone | 206-909-0534
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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 | PH61565986
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License Number State | WA
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