Provider Demographics
NPI:1518296722
Name:LEE, KRISTINA MYUNG JIN MUN (RPH)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MYUNG JIN MUN
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 TALBOTS LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7111
Mailing Address - Country:US
Mailing Address - Phone:972-333-6881
Mailing Address - Fax:
Practice Address - Street 1:711 JORIE BLVD
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4425
Practice Address - Country:US
Practice Address - Phone:630-891-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051293783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist