Provider Demographics
NPI:1699281295
Name:LEE, MICHELLE YOON (RPH)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:YOON
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PATSY PL
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1448
Mailing Address - Country:US
Mailing Address - Phone:516-384-4379
Mailing Address - Fax:
Practice Address - Street 1:5 PATSY PL
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1448
Practice Address - Country:US
Practice Address - Phone:516-384-4379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist