Provider Demographics
NPI:1306030028
Name:LEE, JERRICA LAIFUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JERRICA
Middle Name:LAIFUN
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20261 US HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2953
Mailing Address - Country:US
Mailing Address - Phone:760-242-1323
Mailing Address - Fax:760-242-3662
Practice Address - Street 1:20261 US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2953
Practice Address - Country:US
Practice Address - Phone:760-242-1323
Practice Address - Fax:760-242-3662
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist