Provider Demographics
NPI:1336341254
Name:LEE, JERRY WADE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WADE
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2607
Mailing Address - Country:US
Mailing Address - Phone:806-766-0310
Mailing Address - Fax:806-744-9580
Practice Address - Street 1:1950 ASPEN
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79403
Practice Address - Country:US
Practice Address - Phone:806-766-0268
Practice Address - Fax:806-767-1640
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX362711835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36271OtherLICENSE