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NPI Code Detail

MEDICARE: YOUNGGYEUNG LEE PHARMACIST

MEDICARE: YOUNGGYEUNG LEE PHARMACIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302033839MI

General Provider Information

NPI Number : 1043593130
Entity Type Code : Individual
Provider Name (Legal Business Name) : YOUNGGYEUNG LEE PHARMACIST
Provider Business Mailing Address
First Line : 1815 ROCHESTER RD
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-4136
Country : US
Telephone Number : 248-546-6572
Fax Number :
Provider Business Practice Location Address
First Line : 1815 ROCHESTER RD
Second Line :
City : ROYAL OAK
State : MI
Zip : 48073-4136
Country : US
Telephone Number : 248-546-6572
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2011
Last Update Date : 09/24/2011

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Directions to “ YOUNGGYEUNG LEE PHARMACIST” Practice Location

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