Provider Demographics
NPI:1013573211
Name:LEE, JU HEA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JU HEA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2229
Mailing Address - Country:US
Mailing Address - Phone:415-897-4171
Mailing Address - Fax:415-897-3077
Practice Address - Street 1:1707 GRANT AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-2229
Practice Address - Country:US
Practice Address - Phone:415-897-4171
Practice Address - Fax:415-897-3077
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist