Provider Demographics
NPI:1326126657
Name:LEE, JONGHYUCK PETER (RPH)
Entity Type:Individual
Prefix:MR
First Name:JONGHYUCK
Middle Name:PETER
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:JONGHYUCK
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:14914 W 84TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4246
Mailing Address - Country:US
Mailing Address - Phone:913-894-1721
Mailing Address - Fax:
Practice Address - Street 1:201 W R D MIZE RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-655-5434
Practice Address - Fax:816-655-5438
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist