Provider Demographics
NPI:1134498587
Name:LEE, TANYA MEW HOU
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MEW HOU
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685
Mailing Address - Country:US
Mailing Address - Phone:916-939-6439
Mailing Address - Fax:
Practice Address - Street 1:475 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685
Practice Address - Country:US
Practice Address - Phone:209-267-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist