Provider Demographics
NPI:1811632425
Name:LEE, KWANG SE (PHARMD)
Entity type:Individual
Prefix:
First Name:KWANG SE
Middle Name:
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 1:10945 PRICE MANOR WAY APT 264
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-6045
Mailing Address - Country:US
Mailing Address - Phone:443-285-1858
Mailing Address - Fax:
Practice Address - Street 1:481 N FREDERICK AVE STE 103
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2470
Practice Address - Country:US
Practice Address - Phone:301-298-9890
Practice Address - Fax:301-869-9909
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD28315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist