Provider Demographics
NPI:1154529758
Name:LEE, SUNG IL (PHARMD)
Entity type:Individual
Prefix:
First Name:SUNG
Middle Name:IL
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11542 DECENTE DR
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3868
Mailing Address - Country:US
Mailing Address - Phone:818-766-3413
Mailing Address - Fax:
Practice Address - Street 1:2173 PICKWICK DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6426
Practice Address - Country:US
Practice Address - Phone:805-389-5311
Practice Address - Fax:805-389-5309
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH29930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist