Provider Demographics
NPI:1477828457
Name:LEE, ERIC JEFFERY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JEFFERY
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22277 W 12 MILE RD
Mailing Address - Street 2:APT 29
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-4621
Mailing Address - Country:US
Mailing Address - Phone:248-747-0669
Mailing Address - Fax:
Practice Address - Street 1:22277 W 12 MILE RD
Practice Address - Street 2:APT 29
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4621
Practice Address - Country:US
Practice Address - Phone:248-747-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411167183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist