Provider Demographics
NPI:1033421292
Name:LEE, EUN SICK (RPH, MS)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:SICK
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7968 FORT HUNT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1249
Mailing Address - Country:US
Mailing Address - Phone:703-768-4000
Mailing Address - Fax:703-768-8439
Practice Address - Street 1:7968 FORT HUNT RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22308-1249
Practice Address - Country:US
Practice Address - Phone:703-768-4000
Practice Address - Fax:703-768-8439
Is Sole Proprietor?:No
Enumeration Date:2010-07-04
Last Update Date:2010-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist