Provider Demographics
NPI:1689278210
Name:LEE, CRAIG EDMOND (RPH)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:EDMOND
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 1:572 GELLERT DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1212
Mailing Address - Country:US
Mailing Address - Phone:415-987-2623
Mailing Address - Fax:
Practice Address - Street 1:3040 W TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-6816
Practice Address - Country:US
Practice Address - Phone:909-868-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist