Provider Demographics
NPI:1154179398
Name:LEE, SOO JUNG
Entity type:Individual
Prefix:MS
First Name:SOO
Middle Name:JUNG
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 1:7320 OLD YORK RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3007
Mailing Address - Country:US
Mailing Address - Phone:215-635-6532
Mailing Address - Fax:
Practice Address - Street 1:7320 OLD YORK RD STE 210
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3007
Practice Address - Country:US
Practice Address - Phone:215-635-6532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043216L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist