Provider Demographics
NPI:1174895866
Name:LEE, DOUANENG SAYAXANG (PHARM D)
Entity type:Individual
Prefix:
First Name:DOUANENG
Middle Name:SAYAXANG
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10725 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-2446
Mailing Address - Country:US
Mailing Address - Phone:414-258-8054
Mailing Address - Fax:414-258-2593
Practice Address - Street 1:10725 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-2446
Practice Address - Country:US
Practice Address - Phone:414-258-8054
Practice Address - Fax:414-258-2593
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15565-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist