Provider Demographics
NPI:1629481593
Name:LEE, JENNIFER A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 FOREST PARK BLVD
Mailing Address - Street 2:#B122
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-5392
Mailing Address - Country:US
Mailing Address - Phone:805-604-3059
Mailing Address - Fax:
Practice Address - Street 1:1451 N RICE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7926
Practice Address - Country:US
Practice Address - Phone:805-981-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist