Provider Demographics
NPI:1679008312
Name:LEE, LIEN VINH BAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:LIEN
Middle Name:VINH BAO
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 1:9122 MINEOLA CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-8261
Mailing Address - Country:US
Mailing Address - Phone:703-789-3664
Mailing Address - Fax:
Practice Address - Street 1:3259 CATLIN AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5109
Practice Address - Country:US
Practice Address - Phone:703-784-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202205468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist