Provider Demographics
NPI:1407996739
Name:LEE, RICK (RPH MBA)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 WORTHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4403
Mailing Address - Country:US
Mailing Address - Phone:215-429-9646
Mailing Address - Fax:
Practice Address - Street 1:714 MARKET ST
Practice Address - Street 2:SUITE 312
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-2326
Practice Address - Country:US
Practice Address - Phone:215-429-9646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037515L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP037515LOtherPHARMACIST LICENSE