Provider Demographics
NPI:1154648806
Name:LEE, SUE LING (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUE LING
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E 79TH ST
Mailing Address - Street 2:2ND FLOOR PHARMACY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0819
Mailing Address - Country:US
Mailing Address - Phone:212-879-1600
Mailing Address - Fax:212-879-4594
Practice Address - Street 1:211 E 79TH ST
Practice Address - Street 2:2ND FLOOR PHARMACY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0819
Practice Address - Country:US
Practice Address - Phone:212-879-1600
Practice Address - Fax:212-879-4594
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY335232Medicare UPIN