Basic Information
| Provider Information | |||||||||
| NPI: | 1851986384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JANE | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7021 BEECHFIELD DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO PALOS VERDES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902752911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102658855 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3330 LOMITA BLVD | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905055002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103259110 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2021 | ||||||||
| LastUpdateDate: | 03/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 52512 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.