Provider Demographics
NPI:1861848236
Name:LEE, HAERYUNG
Entity Type:Individual
Prefix:
First Name:HAERYUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22618 HIGHWAY 99 STE 109
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8395
Mailing Address - Country:US
Mailing Address - Phone:425-673-8533
Mailing Address - Fax:425-673-5010
Practice Address - Street 1:22618 HIGHWAY 99 STE 109
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8395
Practice Address - Country:US
Practice Address - Phone:425-673-8533
Practice Address - Fax:425-673-5010
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60074070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist