Provider Demographics
NPI:1831440338
Name:LEE, ELAINE (RPH)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HADDON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-3101
Mailing Address - Country:US
Mailing Address - Phone:856-757-9601
Mailing Address - Fax:
Practice Address - Street 1:1008 SWALLOW DR
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2806
Practice Address - Country:US
Practice Address - Phone:856-616-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03495000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist