Provider Demographics
NPI:1346576071
Name:LEE, ADRENA V (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ADRENA
Middle Name:V
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4327
Mailing Address - Country:US
Mailing Address - Phone:972-329-7440
Mailing Address - Fax:972-329-8275
Practice Address - Street 1:401 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4327
Practice Address - Country:US
Practice Address - Phone:972-329-7440
Practice Address - Fax:972-329-8275
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-31
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43925183500000X
LA16545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist