Provider Demographics
NPI:1083939029
Name:LEE, SUSAN Y (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:Y
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 TERRACE ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1835
Mailing Address - Country:US
Mailing Address - Phone:201-384-7171
Mailing Address - Fax:201-384-4433
Practice Address - Street 1:169 TERRACE ST
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1835
Practice Address - Country:US
Practice Address - Phone:201-384-7171
Practice Address - Fax:201-384-4433
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02397600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist