Provider Demographics
NPI:1215174487
Name:LEE, LETHA B (RPH)
Entity type:Individual
Prefix:MRS
First Name:LETHA
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-3214
Mailing Address - Country:US
Mailing Address - Phone:931-363-2561
Mailing Address - Fax:931-424-3284
Practice Address - Street 1:125 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3214
Practice Address - Country:US
Practice Address - Phone:931-363-2561
Practice Address - Fax:931-424-3284
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist