Provider Demographics
NPI:1518380609
Name:LEE, GLORIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
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 1:704 FALCON CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1849
Mailing Address - Country:US
Mailing Address - Phone:510-725-5782
Mailing Address - Fax:
Practice Address - Street 1:103 W AMERICAN CANYON RD
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1112
Practice Address - Country:US
Practice Address - Phone:707-649-5160
Practice Address - Fax:707-649-5166
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 69494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist