Provider Demographics
NPI:1427377845
Name:LEE, DONG EUN (RPH)
Entity Type:Individual
Prefix:MS
First Name:DONG EUN
Middle Name:
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 1:80 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-8306
Mailing Address - Country:US
Mailing Address - Phone:781-891-9750
Mailing Address - Fax:781-891-3210
Practice Address - Street 1:80 RIVER ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-8306
Practice Address - Country:US
Practice Address - Phone:781-891-9750
Practice Address - Fax:781-891-3210
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist