Provider Demographics
NPI:1205185576
Name:LEE, HENRY K (PHARMD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 KISSENA BLVD
Mailing Address - Street 2:KM PHARMACY LLC
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3127
Mailing Address - Country:US
Mailing Address - Phone:718-888-0110
Mailing Address - Fax:718-888-0093
Practice Address - Street 1:4135 KISSENA BLVD
Practice Address - Street 2:KM PHARMACY LLC
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3127
Practice Address - Country:US
Practice Address - Phone:718-888-0110
Practice Address - Fax:718-888-0093
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist