Provider Demographics
NPI:1730855974
Name:LEE, JASMINE H
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:H
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 1:9580 GARDEN GROVE BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1589
Mailing Address - Country:US
Mailing Address - Phone:714-537-6619
Mailing Address - Fax:714-537-1769
Practice Address - Street 1:9580 GARDEN GROVE BLVD STE 108
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1589
Practice Address - Country:US
Practice Address - Phone:714-537-6619
Practice Address - Fax:714-537-1769
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist