Provider Demographics
NPI:1588740377
Name:LEE, JAE S (RPH)
Entity type:Individual
Prefix:MR
First Name:JAE
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7679 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8687
Mailing Address - Country:US
Mailing Address - Phone:614-733-0808
Mailing Address - Fax:614-336-4486
Practice Address - Street 1:5695 AVERY RD
Practice Address - Street 2:SUITE D
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7097
Practice Address - Country:US
Practice Address - Phone:614-336-4485
Practice Address - Fax:614-336-4486
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-22050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist