Provider Demographics
NPI:1376109124
Name:LEE, JIN HEE HEE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JIN HEE
Middle Name:HEE
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CREST RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1141
Mailing Address - Country:US
Mailing Address - Phone:516-603-0065
Mailing Address - Fax:
Practice Address - Street 1:1710 CROSBY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4902
Practice Address - Country:US
Practice Address - Phone:718-918-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY065163OtherPHARMACIST