Provider Demographics
NPI:1629547393
Name:LEE, STEPHEN SEUNGHYUN (RPH)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SEUNGHYUN
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 1:583 PLAINVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5714
Mailing Address - Country:US
Mailing Address - Phone:516-728-8342
Mailing Address - Fax:
Practice Address - Street 1:216 HENRY ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-6333
Practice Address - Country:US
Practice Address - Phone:516-485-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist