Provider Demographics
NPI:1609198365
Name:LEE, CHU-LIN NELSON (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:CHU-LIN
Middle Name:NELSON
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BAYARD ST
Mailing Address - Street 2:APT. 3-O
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4903
Mailing Address - Country:US
Mailing Address - Phone:917-439-3859
Mailing Address - Fax:
Practice Address - Street 1:7814 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6626
Practice Address - Country:US
Practice Address - Phone:718-478-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY043639OtherPHARMACIST LICENSE NUMBER