Provider Demographics
NPI:1649663329
Name:LEE, JAYDEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JAYDEN
Middle Name:
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 1:919 W RIO ALTAR
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4036
Mailing Address - Country:US
Mailing Address - Phone:818-398-8121
Mailing Address - Fax:
Practice Address - Street 1:919 W RIO ALTAR
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4036
Practice Address - Country:US
Practice Address - Phone:818-398-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0297131835P2201X
AZS0251921835P2201X
CTPCT.0012000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist