Provider Demographics
NPI:1790280956
Name:LEE, CHIA-JUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHIA-JUNG
Middle Name:
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 1:82491 AVENUE 42
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9307
Mailing Address - Country:US
Mailing Address - Phone:760-262-8004
Mailing Address - Fax:
Practice Address - Street 1:82491 AVENUE 42
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-9307
Practice Address - Country:US
Practice Address - Phone:760-262-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist