Provider Demographics
NPI:1073913919
Name:LEE, MICHELLE EUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EUN
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 1:102 NORTH BICKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549
Mailing Address - Country:US
Mailing Address - Phone:919-497-3041
Mailing Address - Fax:
Practice Address - Street 1:102 N. BICKETT BLVD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549
Practice Address - Country:US
Practice Address - Phone:919-497-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24371OtherNORTH CAROLINA BOARD OF PHARMACY