Provider Demographics
NPI:1861716128
Name:LEE, YOUNG S (PHARMACIST)
Entity type:Individual
Prefix:MS
First Name:YOUNG
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 54TH ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4207
Mailing Address - Country:US
Mailing Address - Phone:718-672-9337
Mailing Address - Fax:212-598-6198
Practice Address - Street 1:1639 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4646
Practice Address - Country:US
Practice Address - Phone:212-879-1258
Practice Address - Fax:212-737-4656
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist