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General NPI Number Information
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NPI Number | 1811630593
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Entity Type | Individual
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Provider Name | JIN AH LEE
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Gender | Female
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 2720 S HIGHLAND AVE APT 320
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City | LOMBARD
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State | IL
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Zip | 60148-5399
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Country | US
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Telephone | 562-410-7953
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Fax |
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Provider Business Mailing Address
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Address Line | 324 ROOSEVELT RD
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City | GLEN ELLYN
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State | IL
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Zip | 60137-5647
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Country | US
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Telephone | 562-410-7953
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 051304675
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License Number State | IL
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