Provider Demographics
NPI:1548387608
Name:LEE, JAEIK (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAEIK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 LAKE RESORT DR APT K110
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-7046
Mailing Address - Country:US
Mailing Address - Phone:423-877-0774
Mailing Address - Fax:
Practice Address - Street 1:5750 LAKE RESORT DR APT K110
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-7046
Practice Address - Country:US
Practice Address - Phone:423-877-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist