Provider Demographics
NPI:1437755295
Name:LEE, MARSHALL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:
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 1:3680 WASHINGTON AVE APT C
Mailing Address - Street 2:
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-1737
Mailing Address - Country:US
Mailing Address - Phone:612-759-9260
Mailing Address - Fax:
Practice Address - Street 1:3680 WASHINGTON AVE APT C
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-1737
Practice Address - Country:US
Practice Address - Phone:612-759-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.302482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty