Provider Demographics
NPI:1710215272
Name:LEE, JONATHAN ART (PHARMD, RPH, CCP)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ART
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD, RPH, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 MAIN ST
Mailing Address - Street 2:PO BOX 130
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-1734
Mailing Address - Country:US
Mailing Address - Phone:732-787-1414
Mailing Address - Fax:
Practice Address - Street 1:199 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-1734
Practice Address - Country:US
Practice Address - Phone:732-787-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03318400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist