Provider Demographics
NPI:1396086856
Name:LEE, CHIYON
Entity type:Individual
Prefix:
First Name:CHIYON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 KERNE CT.
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029
Mailing Address - Country:US
Mailing Address - Phone:443-663-6116
Mailing Address - Fax:443-663-6108
Practice Address - Street 1:6321 KERNE CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1558
Practice Address - Country:US
Practice Address - Phone:443-663-6116
Practice Address - Fax:443-663-6108
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist