Provider Demographics
NPI:1629671151
Name:LEE, EUNJEE JOSEPHINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:EUNJEE
Middle Name:JOSEPHINE
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:3 COLBY CT
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2639
Mailing Address - Country:US
Mailing Address - Phone:860-930-6817
Mailing Address - Fax:
Practice Address - Street 1:111 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2507
Practice Address - Country:US
Practice Address - Phone:860-693-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist