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General NPI Number Information
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NPI Number | 1952787715
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Entity Type | Individual
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Provider Name | JONATHAN LEE PHARMD, RPH
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Gender | Male
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 210 VILLAGE CENTER DR
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City | LUSBY
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State | MD
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Zip | 20657-6531
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Country | US
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Telephone | 410-394-3711
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Fax | 410-394-3799
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Provider Business Mailing Address
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Address Line | 6 RUSTIC AVE
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City | MEDFORD
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State | NY
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Zip | 11763-4421
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Country | US
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Telephone | 631-747-6215
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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 | 0202215284
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24660
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 060761
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License Number State | NY
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