Provider Demographics
NPI:1972017259
Name:LEE, DAVID TAK WAI (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TAK WAI
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 1:27 SHERIDAN DR APT 6
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3817
Mailing Address - Country:US
Mailing Address - Phone:808-256-4740
Mailing Address - Fax:
Practice Address - Street 1:4 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4004
Practice Address - Country:US
Practice Address - Phone:781-821-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-26
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist