Provider Demographics
NPI:1083979892
Name:LEE, RICH CHWIWON (PHARMD)
Entity Type:Individual
Prefix:
First Name:RICH
Middle Name:CHWIWON
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43542 HERITAGE GAP TER
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-5821
Mailing Address - Country:US
Mailing Address - Phone:571-308-5780
Mailing Address - Fax:
Practice Address - Street 1:12200 FAIRFAX TOWNE CTR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2877
Practice Address - Country:US
Practice Address - Phone:703-359-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist