Provider Demographics
NPI:1457621757
Name:LEE, SAEROM (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SAEROM
Middle Name:
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 1:6700 192ND ST
Mailing Address - Street 2:APT#2108
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3774
Mailing Address - Country:US
Mailing Address - Phone:516-242-6993
Mailing Address - Fax:
Practice Address - Street 1:6700 192ND ST
Practice Address - Street 2:APT#2108
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3774
Practice Address - Country:US
Practice Address - Phone:516-242-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI056310-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist