Provider Demographics
NPI:1962684399
Name:LEE, YOON H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YOON
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 WHITMAN ST
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1315
Mailing Address - Country:US
Mailing Address - Phone:201-244-5866
Mailing Address - Fax:
Practice Address - Street 1:307 WHITMAN ST
Practice Address - Street 2:
Practice Address - City:HAWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07641-1315
Practice Address - Country:US
Practice Address - Phone:201-290-5177
Practice Address - Fax:201-244-5866
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029921OtherEDUCATION DEPT OF STATE