Provider Demographics
NPI:1396045605
Name:LEE, JI Y (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:JI
Middle Name:Y
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 1:20211 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-4000
Mailing Address - Country:US
Mailing Address - Phone:301-670-1631
Mailing Address - Fax:301-670-1642
Practice Address - Street 1:20211 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-4000
Practice Address - Country:US
Practice Address - Phone:301-670-1631
Practice Address - Fax:301-670-1642
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist