Provider Demographics
NPI:1063402642
Name:LEE, GROVER (PHARMD, BCMCM)
Entity type:Individual
Prefix:DR
First Name:GROVER
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD, BCMCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4404
Mailing Address - Country:US
Mailing Address - Phone:800-872-8276
Mailing Address - Fax:916-960-0342
Practice Address - Street 1:2217 PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4404
Practice Address - Country:US
Practice Address - Phone:800-872-8276
Practice Address - Fax:916-960-0342
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288651835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy