Provider Demographics
NPI:1497075899
Name:LEE, JONG CHUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONG
Middle Name:CHUL
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 1:1432 UPLAND HILLS DR S
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-2430
Mailing Address - Country:US
Mailing Address - Phone:909-608-0754
Mailing Address - Fax:
Practice Address - Street 1:1050 N MOUNTAIN AVE
Practice Address - Street 2:RITE AID
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-2114
Practice Address - Country:US
Practice Address - Phone:909-986-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53226183500000X
NV15562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist