Basic Information
| Provider Information | |||||||||
| NPI: | 1679174502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | SUNNY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PHARMACIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10523 VINCENT RD | ||||||||
| Address2: | |||||||||
| City: | WHITE MARSH | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211621922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104582834 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8118 PERRY HILLS CT | ||||||||
| Address2: | |||||||||
| City: | NOTTINGHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212363514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108829943 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2020 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 16247 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.