Provider Demographics
NPI:1538281027
Name:LEE, JIN S (RPH)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:S
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 1:647 SE NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-2935
Mailing Address - Country:US
Mailing Address - Phone:541-994-6262
Mailing Address - Fax:541-994-4713
Practice Address - Street 1:4041 NW LOGAN RD
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5054
Practice Address - Country:US
Practice Address - Phone:541-994-6262
Practice Address - Fax:541-994-4713
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH0010703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist