Provider Demographics
NPI:1154404424
Name:LEE, YOUNG J (OWNER)
Entity type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1146
Mailing Address - Country:US
Mailing Address - Phone:201-653-3154
Mailing Address - Fax:201-653-7576
Practice Address - Street 1:161 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1146
Practice Address - Country:US
Practice Address - Phone:201-653-3154
Practice Address - Fax:201-653-7576
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS007075003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy