Provider Demographics
NPI:1588933709
Name:LEE, ALLEN B (RPH)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:B
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 1:606 LEAGUE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4824
Mailing Address - Country:US
Mailing Address - Phone:215-668-6012
Mailing Address - Fax:
Practice Address - Street 1:2014 S BROAD ST # 24
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2305
Practice Address - Country:US
Practice Address - Phone:215-551-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045009L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist