Provider Demographics
NPI:1336421478
Name:LEE, JOHN L (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BANCROFT AVE STE 268
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2468
Mailing Address - Country:US
Mailing Address - Phone:510-638-7323
Mailing Address - Fax:510-430-2860
Practice Address - Street 1:7200 BANCROFT AVE STE 268
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2468
Practice Address - Country:US
Practice Address - Phone:510-638-7323
Practice Address - Fax:510-430-2860
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist