Provider Demographics
NPI:1366432205
Name:WERTS, LEE KURTIS (RPH01)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:KURTIS
Last Name:WERTS
Suffix:
Gender:M
Credentials:RPH01
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11521 DOVE LN
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-9695
Mailing Address - Country:US
Mailing Address - Phone:419-394-5671
Mailing Address - Fax:
Practice Address - Street 1:1020 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1047
Practice Address - Country:US
Practice Address - Phone:419-586-1340
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-13360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist