Provider Demographics
NPI:1720508484
Name:LEE, MATTHEW CHIYULE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHIYULE
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 1:7400 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2818
Mailing Address - Country:US
Mailing Address - Phone:818-776-2600
Mailing Address - Fax:
Practice Address - Street 1:7400 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2818
Practice Address - Country:US
Practice Address - Phone:818-776-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist