Provider Demographics
NPI:1700064961
Name:LEE, DANBI
Entity Type:Individual
Prefix:
First Name:DANBI
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 1:23730 CLARKSMEADE DR
Mailing Address - Street 2:UNIT 303
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-5304
Mailing Address - Country:US
Mailing Address - Phone:240-277-4069
Mailing Address - Fax:
Practice Address - Street 1:504 E RIDGEVILLE BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5252
Practice Address - Country:US
Practice Address - Phone:301-829-6402
Practice Address - Fax:301-829-6404
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16383OtherMD PHARMACIST