Provider Demographics
NPI:1346236965
Name:LEE, WILLIAM T (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:T
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 W HADDON AVE
Mailing Address - Street 2:UNIT #2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5492
Mailing Address - Country:US
Mailing Address - Phone:312-771-0200
Mailing Address - Fax:312-275-7177
Practice Address - Street 1:2427 W HADDON AVE
Practice Address - Street 2:UNIT #2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5492
Practice Address - Country:US
Practice Address - Phone:312-771-0200
Practice Address - Fax:312-275-7177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL05129392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist