Active NPI
Jaeyeon Lee
- Pharmacist
- Moses Lake, WA
National Provider Identifier
1184434854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH61565986
- Practice address
- 500 S Pioneer Way
Moses Lake, WA 98837-1812 - Phone
- (509) 765-1219
- NPI assigned
- Jan 13, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH61565986 | WA | Primary |
Addresses
Primary practice location
500 S Pioneer Way
Moses Lake, WA 98837-1812
Mailing address
601 S Division St Apt 6
Moses Lake, WA 98837-3822
Phone (206) 909-0534
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH61565986 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrifty Payless Inc | Past | Accepting new patients | |
| Thrifty Payless Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Moses Lake, WA
- NPI 1417066739
-
- Community/Retail Pharmacy
- Winchester, CA
- NPI 1437874062
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736726400000",
"number": "1184434854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 S DIVISION ST APT 6",
"city": "MOSES LAKE",
"state": "WA",
"postal_code": "988373822",
"telephone_number": "206-909-0534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 S PIONEER WAY",
"city": "MOSES LAKE",
"state": "WA",
"postal_code": "988371812",
"telephone_number": "509-765-1219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JAEYEON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-01-13",
"last_updated": "2025-01-13",
"certification_date": "2025-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH61565986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moses Lake, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.