Provider Demographics
NPI:1306864632
Name:LEE, LISA SUNG EUN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SUNG EUN
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 1:6900 ALDEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:FE WARREN AFB
Mailing Address - State:WY
Mailing Address - Zip Code:82005
Mailing Address - Country:US
Mailing Address - Phone:307-773-6248
Mailing Address - Fax:307-773-4589
Practice Address - Street 1:6900 ALDEN DRIVE
Practice Address - Street 2:
Practice Address - City:FE WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005
Practice Address - Country:US
Practice Address - Phone:307-773-6248
Practice Address - Fax:307-773-4589
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02871300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist