Provider Demographics
NPI:1730622663
Name:LEE, JENNY YOUNG (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:YOUNG
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 1:6 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3422
Mailing Address - Country:US
Mailing Address - Phone:310-634-6317
Mailing Address - Fax:
Practice Address - Street 1:16773 BERNARDO CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2525
Practice Address - Country:US
Practice Address - Phone:858-451-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-26
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist