Provider Demographics
NPI:1407017551
Name:LEE, KAN Y (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KAN
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S JOYCE ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2079
Mailing Address - Country:US
Mailing Address - Phone:703-413-6280
Mailing Address - Fax:703-413-6286
Practice Address - Street 1:1301 S JOYCE ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2079
Practice Address - Country:US
Practice Address - Phone:703-413-6280
Practice Address - Fax:703-413-6286
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist