Provider Demographics
NPI:1114209384
Name:LEE, TIMOTHY (RPH)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-2210
Mailing Address - Country:US
Mailing Address - Phone:219-844-5034
Mailing Address - Fax:219-845-5014
Practice Address - Street 1:6905 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-2210
Practice Address - Country:US
Practice Address - Phone:219-844-5034
Practice Address - Fax:219-845-5014
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019249A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist