Provider Demographics
NPI:1427700384
Name:LEE, ELENA (PHARMD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
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 1:12746 W JEFFERSON BLVD STE 3160
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2778
Mailing Address - Country:US
Mailing Address - Phone:310-862-9810
Mailing Address - Fax:310-962-9811
Practice Address - Street 1:12746 W JEFFERSON BLVD STE 3160
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2778
Practice Address - Country:US
Practice Address - Phone:310-862-9810
Practice Address - Fax:310-862-9811
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist