Provider Demographics
NPI:1871071142
Name:LEE, MIKYOUNG
Entity type:Individual
Prefix:
First Name:MIKYOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6509
Mailing Address - Country:US
Mailing Address - Phone:702-473-9752
Mailing Address - Fax:702-489-9782
Practice Address - Street 1:2908 BELMONT DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6509
Practice Address - Country:US
Practice Address - Phone:702-473-9752
Practice Address - Fax:702-489-9782
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPT06777183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician