Provider Demographics
NPI:1649863341
Name:LEE, ANTONIO CARLOS
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:CARLOS
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3558 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5203
Mailing Address - Country:US
Mailing Address - Phone:718-676-4966
Mailing Address - Fax:718-676-4967
Practice Address - Street 1:3558 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5203
Practice Address - Country:US
Practice Address - Phone:718-676-4966
Practice Address - Fax:718-676-4967
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy