Provider Demographics
NPI:1093431579
Name:LEE, JENNIFER JEESU (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEESU
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 1:11549 YARD ST APT 548
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-0047
Mailing Address - Country:US
Mailing Address - Phone:317-459-5949
Mailing Address - Fax:
Practice Address - Street 1:2419 NICHOL AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-3070
Practice Address - Country:US
Practice Address - Phone:765-643-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029791A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy