Provider Demographics
NPI:1417221987
Name:LEE, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-2038
Mailing Address - Country:US
Mailing Address - Phone:910-628-6068
Mailing Address - Fax:910-628-9059
Practice Address - Street 1:414 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-2038
Practice Address - Country:US
Practice Address - Phone:910-628-6068
Practice Address - Fax:910-628-9059
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8498183500000X
SC5567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist