Provider Demographics
NPI:1154695021
Name:LEE, KEVAN MARIE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KEVAN
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
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 1:309 ROLLING HILLS VLG
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8051
Mailing Address - Country:US
Mailing Address - Phone:304-376-1709
Mailing Address - Fax:
Practice Address - Street 1:436 RETAIL COMMONS PKWY
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6183
Practice Address - Country:US
Practice Address - Phone:304-264-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist