Provider Demographics
NPI:1508232703
Name:LEE, LIN-FOO SAM (PHARM D)
Entity Type:Individual
Prefix:
First Name:LIN-FOO
Middle Name:SAM
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-3036
Mailing Address - Country:US
Mailing Address - Phone:208-585-2900
Mailing Address - Fax:208-585-3057
Practice Address - Street 1:430 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-3036
Practice Address - Country:US
Practice Address - Phone:208-585-2900
Practice Address - Fax:208-585-3057
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP4909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist