Active NPI
Jin Ki Lee, PHARMD
- Pharmacist
- Edgewood, MD
National Provider Identifier
1467798264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20774
- Practice address
- 1930 Pulaski Hwy
Edgewood, MD 21040-1612 - Phone
- (410) 671-6568
- NPI assigned
- Dec 26, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20774 | MD | Primary |
| Pharmacist | 183500000X | 0202211822 | VA |
Addresses
Primary practice location
1930 Pulaski Hwy
Edgewood, MD 21040-1612
Mailing address
1930 Pulaski Hwy
Edgewood, MD 21040-1612
Phone (410) 671-6568
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20774 | MD | MD | Clinical Social Worker |
| 0202211822 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356480000000",
"number": "1467798264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1930 PULASKI HWY",
"city": "EDGEWOOD",
"state": "MD",
"postal_code": "210401612",
"telephone_number": "410-671-6568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1930 PULASKI HWY",
"city": "EDGEWOOD",
"state": "MD",
"postal_code": "210401612",
"telephone_number": "410-671-6568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JIN",
"middle_name": "KI",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-26",
"last_updated": "2012-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "20774",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202211822",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edgewood, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.