Provider Demographics
NPI:1548241193
Name:LEE, JIMMY (BS, MBA, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:BS, MBA, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14006 COUGAR POINT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5924
Mailing Address - Country:US
Mailing Address - Phone:210-916-4682
Mailing Address - Fax:210-916-3481
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-539-9582
Practice Address - Fax:210-916-3481
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27921183500000X, 1835P0018X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist