Provider Demographics
NPI:1770802118
Name:LEE, SHI-FANG JOANN (PHARMD)
Entity type:Individual
Prefix:
First Name:SHI-FANG
Middle Name:JOANN
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1507
Mailing Address - Country:US
Mailing Address - Phone:201-489-7805
Mailing Address - Fax:201-489-6465
Practice Address - Street 1:33 RIVER RD
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1507
Practice Address - Country:US
Practice Address - Phone:201-489-7805
Practice Address - Fax:201-489-6465
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03089100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03089100OtherPHARMACY LICENSE NUMBER