Provider Demographics
NPI:1386945335
Name:LEE, SANG MIN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:SANG
Middle Name:MIN
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3602
Mailing Address - Country:US
Mailing Address - Phone:360-659-2882
Mailing Address - Fax:360-658-0435
Practice Address - Street 1:1258 STATE AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3602
Practice Address - Country:US
Practice Address - Phone:360-659-2882
Practice Address - Fax:360-658-0435
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00055523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist