Provider Demographics
NPI:1306203518
Name:LEE-STALDER, YI-MING (RPH)
Entity type:Individual
Prefix:
First Name:YI-MING
Middle Name:
Last Name:LEE-STALDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1811
Mailing Address - Country:US
Mailing Address - Phone:602-264-1444
Mailing Address - Fax:602-264-1443
Practice Address - Street 1:1111 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1811
Practice Address - Country:US
Practice Address - Phone:602-264-1444
Practice Address - Fax:602-264-1443
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZB11579140OtherDRIVER'S LICENSE