Provider Demographics
NPI:1518247212
Name:LEE, KIM S (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:S
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 1:352 HEWLETT PKWY
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1204
Mailing Address - Country:US
Mailing Address - Phone:516-507-4387
Mailing Address - Fax:
Practice Address - Street 1:1 CVS DRIVE
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-1204
Practice Address - Country:US
Practice Address - Phone:401-765-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist