Provider Demographics
NPI:1588325880
Name:LEE, SANG BOK (PHARMD)
Entity type:Individual
Prefix:
First Name:SANG BOK
Middle Name:
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 1:241 FARENHOLT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3222
Mailing Address - Country:US
Mailing Address - Phone:671-647-1193
Mailing Address - Fax:671-647-1194
Practice Address - Street 1:241 FARENHOLT AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3222
Practice Address - Country:US
Practice Address - Phone:671-647-1193
Practice Address - Fax:671-647-1194
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPH0453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist