Provider Demographics
NPI:1770122285
Name:LEE, KEVIN K (RPH)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:KAM-CHUEN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11940 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3514
Mailing Address - Country:US
Mailing Address - Phone:626-350-1052
Mailing Address - Fax:626-350-8122
Practice Address - Street 1:11940 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3514
Practice Address - Country:US
Practice Address - Phone:626-350-1052
Practice Address - Fax:626-350-8122
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist