Provider Demographics
NPI:1316308737
Name:LEE, MICHAEL G (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
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 1:650 TABOR PL
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5328
Mailing Address - Country:US
Mailing Address - Phone:201-407-4144
Mailing Address - Fax:
Practice Address - Street 1:2151 JOHNSTON PL
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3608
Practice Address - Country:US
Practice Address - Phone:516-378-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03756500183500000X
NY063682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist