Provider Demographics
NPI:1245641687
Name:LEE, LIH GEN (TRACY)
Entity type:Individual
Prefix:
First Name:LIH GEN (TRACY)
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13451 BASELINE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5472
Mailing Address - Country:US
Mailing Address - Phone:909-463-4631
Mailing Address - Fax:909-463-0945
Practice Address - Street 1:13451 BASELINE AVE STE C
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5472
Practice Address - Country:US
Practice Address - Phone:909-463-4631
Practice Address - Fax:909-463-0945
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH48159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist