Provider Demographics
NPI:1821271701
Name:LEE, KEN WOO (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:WOO
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:KUN
Other - Middle Name:WOO
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:3841 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1949
Mailing Address - Country:US
Mailing Address - Phone:917-656-6325
Mailing Address - Fax:
Practice Address - Street 1:2232 PITKIN AVE
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3621
Practice Address - Country:US
Practice Address - Phone:917-656-6325
Practice Address - Fax:516-441-5400
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist