Provider Demographics
NPI:1427429091
Name:LEE, JUSTINE MAI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:MAI
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2910
Mailing Address - Country:US
Mailing Address - Phone:562-698-4906
Mailing Address - Fax:
Practice Address - Street 1:14885 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1060
Practice Address - Country:US
Practice Address - Phone:562-777-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist