Provider Demographics
NPI:1598087876
Name:LEE, WILLIAM KEVIN (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KEVIN
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 1:44 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3817
Mailing Address - Country:US
Mailing Address - Phone:516-872-6861
Mailing Address - Fax:516-872-8109
Practice Address - Street 1:44 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3817
Practice Address - Country:US
Practice Address - Phone:516-872-6861
Practice Address - Fax:516-872-8109
Is Sole Proprietor?:No
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044032-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist