Provider Demographics
NPI:1215062872
Name:LEE, STEPHEN C (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
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 1:21 MANZANITA AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4247
Mailing Address - Country:US
Mailing Address - Phone:650-291-1295
Mailing Address - Fax:
Practice Address - Street 1:1400 LINDA MAR SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3340
Practice Address - Country:US
Practice Address - Phone:650-359-6691
Practice Address - Fax:650-359-7346
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist