Provider Demographics
NPI:1669766432
Name:LEE, YONGEUN
Entity type:Individual
Prefix:
First Name:YONGEUN
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 1:94 STATE RT 23
Mailing Address - Street 2:T-2247
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1208
Mailing Address - Country:US
Mailing Address - Phone:973-850-2862
Mailing Address - Fax:973-850-2872
Practice Address - Street 1:94 STATE RT 23
Practice Address - Street 2:T-2247
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1208
Practice Address - Country:US
Practice Address - Phone:973-850-2862
Practice Address - Fax:973-850-2872
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03242100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist