Provider Demographics
NPI:1336675149
Name:LEE, WALTER CHONGHWA (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:CHONGHWA
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 MOUNT HERMON RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4037
Mailing Address - Country:US
Mailing Address - Phone:831-438-5920
Mailing Address - Fax:831-438-7800
Practice Address - Street 1:257 MOUNT HERMON RD
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4037
Practice Address - Country:US
Practice Address - Phone:831-438-5920
Practice Address - Fax:831-438-7800
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist