Provider Demographics
NPI:1114221306
Name:LEE, PAULINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:
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 1:1051 HUME WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5558
Mailing Address - Country:US
Mailing Address - Phone:707-453-7342
Mailing Address - Fax:707-453-7363
Practice Address - Street 1:1051 HUME WAY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5558
Practice Address - Country:US
Practice Address - Phone:707-453-7342
Practice Address - Fax:707-453-7363
Is Sole Proprietor?:No
Enumeration Date:2011-01-01
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 0424491835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist