Provider Demographics
NPI:1003887506
Name:LEE, VINCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:VINCE
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:YOUA
Other - Middle Name:VINCE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10764 N ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9533
Mailing Address - Country:US
Mailing Address - Phone:559-824-3714
Mailing Address - Fax:559-454-8095
Practice Address - Street 1:10764 N ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-9533
Practice Address - Country:US
Practice Address - Phone:559-824-3714
Practice Address - Fax:559-454-8095
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 51448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 51448OtherREGISTERED PHARMACIST