Provider Demographics
NPI:1841503653
Name:LEE, STACEY (PHARMD, RPH,)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD, RPH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 NEWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-9524
Mailing Address - Country:US
Mailing Address - Phone:215-820-7154
Mailing Address - Fax:
Practice Address - Street 1:7564 HAVERFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2112
Practice Address - Country:US
Practice Address - Phone:215-878-4636
Practice Address - Fax:215-878-0254
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist