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General NPI Number Information
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NPI Number | 1780243550
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Entity Type | Individual
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Provider Name | JONATHAN LEE
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Gender | Male
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 640 EDITH AVE
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City | CORNING
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State | CA
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Zip | 96021-2349
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Country | US
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Telephone | 530-826-5086
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Fax |
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Provider Business Mailing Address
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Address Line | 4070 NORD HWY APT 121
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City | CHICO
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State | CA
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Zip | 95973-9670
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Country | US
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Telephone |
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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 | 80034
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License Number State | CA
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