Provider Demographics
NPI:1497151658
Name:LEE, ANGELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 INVERRARY LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3612
Mailing Address - Country:US
Mailing Address - Phone:773-988-2479
Mailing Address - Fax:
Practice Address - Street 1:25901 N RIVERWOODS RD
Practice Address - Street 2:
Practice Address - City:METTAWA
Practice Address - State:IL
Practice Address - Zip Code:60045-3403
Practice Address - Country:US
Practice Address - Phone:247-235-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051295396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist