Provider Demographics
NPI:1306167465
Name:LEE, BUNNY (PHARM D)
Entity type:Individual
Prefix:MR
First Name:BUNNY
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1701
Mailing Address - Country:US
Mailing Address - Phone:510-799-1252
Mailing Address - Fax:510-799-2122
Practice Address - Street 1:1560 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-1701
Practice Address - Country:US
Practice Address - Phone:510-799-1252
Practice Address - Fax:510-799-2122
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist