Provider Demographics
NPI:1417258641
Name:LEE, RAYMOND (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 EDGEWATER PKWY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1205
Mailing Address - Country:US
Mailing Address - Phone:301-431-0339
Mailing Address - Fax:
Practice Address - Street 1:116 UNIVERSITY BLVD
Practice Address - Street 2:SAFEWAY PHARMACY 4817
Practice Address - City:SILVERSPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:301-593-8092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist