Provider Demographics
NPI:1942913660
Name:LEE, SAMUEL SHIK
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:SHIK
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 N ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2360
Mailing Address - Country:US
Mailing Address - Phone:502-558-1174
Mailing Address - Fax:
Practice Address - Street 1:260 LOGISTICS AVE STE B
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4672
Practice Address - Country:US
Practice Address - Phone:812-850-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020597A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist