Provider Demographics
NPI:1942439153
Name:LEE, ANITA (RPH)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MIDLAND GARDENS, #3L
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-4710
Mailing Address - Country:US
Mailing Address - Phone:914-793-0205
Mailing Address - Fax:
Practice Address - Street 1:7 MIDLAND GDNS APT 3L
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-4710
Practice Address - Country:US
Practice Address - Phone:914-793-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
034164OtherPHARMACIST LLICENSE