Provider Demographics
NPI:1114200615
Name:LEE, CHEUKFUNG JONATHAN (PHARMD/PHD)
Entity Type:Individual
Prefix:DR
First Name:CHEUKFUNG
Middle Name:JONATHAN
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD/PHD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:CHEUKFUNG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD/PHD
Mailing Address - Street 1:2812 JOY RD
Mailing Address - Street 2:APT 55
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3550
Mailing Address - Country:US
Mailing Address - Phone:865-201-3240
Mailing Address - Fax:888-529-2516
Practice Address - Street 1:3650 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6520
Practice Address - Country:US
Practice Address - Phone:707-210-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist