Provider Demographics
NPI:1255862694
Name:LEE, MARY Z (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:Z
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3107
Mailing Address - Country:US
Mailing Address - Phone:415-482-6900
Mailing Address - Fax:415-482-6903
Practice Address - Street 1:1033 3RD ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3107
Practice Address - Country:US
Practice Address - Phone:415-482-6900
Practice Address - Fax:415-482-6903
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist