Provider Demographics
NPI:1275848343
Name:LEE, SYLVIA ADONICA
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:ADONICA
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 1:313 W ESPERANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-2708
Mailing Address - Country:US
Mailing Address - Phone:520-648-2417
Mailing Address - Fax:520-625-5118
Practice Address - Street 1:313 W ESPERANZA BLVD
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-2708
Practice Address - Country:US
Practice Address - Phone:520-648-2417
Practice Address - Fax:520-625-5118
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS005710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist