Provider Demographics
NPI:1609591924
Name:LEE, LEENA (BSRPH)
Entity Type:Individual
Prefix:MRS
First Name:LEENA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:BSRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WINTER ST APT 21C
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0989
Mailing Address - Country:US
Mailing Address - Phone:781-820-8356
Mailing Address - Fax:
Practice Address - Street 1:16 WINTER ST APT 21C
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0989
Practice Address - Country:US
Practice Address - Phone:781-863-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist