MEDICARE: JU WON LEE

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
1	183500000X	Pharmacist	PH60472209	WA
2	183500000X	Pharmacist	S023556	AZ

General Provider Information

NPI Number	:	1568854982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JU WON LEE

Provider Business Mailing Address
First Line	:	8809 S POINTE PKWY E APT 1144
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7759
Country	:	US
Telephone Number	:	720-933-1448
Fax Number	:

Provider Business Practice Location Address
First Line	:	8809 S POINTE PKWY E APT 1144
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7759
Country	:	US
Telephone Number	:	720-933-1448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2015
Last Update Date	:	08/25/2020

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Directions to “ JU WON LEE ” Practice Location

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