Provider Demographics
NPI:1710744610
Name:LEE, SAMUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 W INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2247
Mailing Address - Country:US
Mailing Address - Phone:520-744-1054
Mailing Address - Fax:520-744-4061
Practice Address - Street 1:3785 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2247
Practice Address - Country:US
Practice Address - Phone:520-744-1054
Practice Address - Fax:520-744-4061
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist