Provider Demographics
NPI:1568596872
Name:LEE, SOOYONG (RPH)
Entity Type:Individual
Prefix:MR
First Name:SOOYONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CARPENTER RD SE APT C6
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6516
Mailing Address - Country:US
Mailing Address - Phone:360-481-1834
Mailing Address - Fax:
Practice Address - Street 1:201 CARPENTER RD SE APT C6
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6516
Practice Address - Country:US
Practice Address - Phone:360-481-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00018333OtherPHARMACIST