Provider Demographics
NPI:1104201003
Name:LEE, KRISTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
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 1:5947 CHALKVILLE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3354
Mailing Address - Country:US
Mailing Address - Phone:205-655-5189
Mailing Address - Fax:
Practice Address - Street 1:5947 CHALKVILLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3354
Practice Address - Country:US
Practice Address - Phone:205-655-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist