Provider Demographics
NPI:1538503867
Name:LEE, SPENCER EVAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:EVAN
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 AUSTIN ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1813
Mailing Address - Country:US
Mailing Address - Phone:718-744-4241
Mailing Address - Fax:
Practice Address - Street 1:8333 AUSTIN ST APT 3L
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1813
Practice Address - Country:US
Practice Address - Phone:718-744-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist