Provider Demographics
NPI:1700159787
Name:LEE, ANDY
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
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 1:8955 SE 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3765
Mailing Address - Country:US
Mailing Address - Phone:503-788-2033
Mailing Address - Fax:503-788-2027
Practice Address - Street 1:8955 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3765
Practice Address - Country:US
Practice Address - Phone:503-788-2033
Practice Address - Fax:503-788-2027
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010861183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist