Provider Demographics
NPI:1942690433
Name:LEE, KATHERINE T
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:T
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 1:5001 STICKLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2221
Mailing Address - Country:US
Mailing Address - Phone:240-277-0217
Mailing Address - Fax:301-945-4970
Practice Address - Street 1:5700 BOU AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1663
Practice Address - Country:US
Practice Address - Phone:301-945-0019
Practice Address - Fax:301-945-4970
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT15115183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician