Provider Demographics
NPI:1396012068
Name:LEE, LYNN M (RPH)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5148
Mailing Address - Country:US
Mailing Address - Phone:262-542-9935
Mailing Address - Fax:262-542-8745
Practice Address - Street 1:230 MADISON ST
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5148
Practice Address - Country:US
Practice Address - Phone:262-542-9935
Practice Address - Fax:262-542-8745
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10705-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist