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General NPI Number Information
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NPI Number | 1811632425
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Entity Type | Individual
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Provider Name | KWANG SE LEE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2022
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 481 N FREDERICK AVE STE 103
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2470
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Country | US
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Telephone | 301-298-9890
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Fax | 301-869-9909
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Provider Business Mailing Address
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Address Line | 10945 PRICE MANOR WAY APT 264
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City | LAUREL
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State | MD
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Zip | 20723-6045
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Country | US
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Telephone | 443-285-1858
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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 | 28315
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License Number State | MD
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