Provider Demographics
NPI:1528468634
Name:LEE, STELLA
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 E HILLCREST DR
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5820
Mailing Address - Country:US
Mailing Address - Phone:805-374-7551
Mailing Address - Fax:
Practice Address - Street 1:365 E HILLCREST DR
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5820
Practice Address - Country:US
Practice Address - Phone:805-374-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist