Provider Demographics
NPI:1003198532
Name:LEE, WING-YAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:WING-YAN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18130 66TH CT APT 205
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4170
Mailing Address - Country:US
Mailing Address - Phone:646-354-8624
Mailing Address - Fax:
Practice Address - Street 1:3564 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3315
Practice Address - Country:US
Practice Address - Phone:708-895-7937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL51-291026183500000X
TN22431183500000X
NY050719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist