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Individual
JONG DAE LEE
Active
Individual
JONG DAE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
033021-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02664726
—
NY
01
—
027296
PHARMACY
NY
01
—
033021-1
NY LICENSE NO.
NY
Enumeration date
08/29/2008
Last updated
09/28/2011
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