Provider Demographics
NPI:1568854982
Name:LEE, JU WON
Entity Type:Individual
Prefix:
First Name:JU WON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8809 S POINTE PKWY E APT 1144
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7759
Mailing Address - Country:US
Mailing Address - Phone:720-933-1448
Mailing Address - Fax:
Practice Address - Street 1:8809 S POINTE PKWY E APT 1144
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7759
Practice Address - Country:US
Practice Address - Phone:720-933-1448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-22
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60472209183500000X
AZS023556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist