Provider Demographics
NPI:1104401603
Name:LEE, KEVIN VIRGIL (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:VIRGIL
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 1:1445 W ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1103
Mailing Address - Country:US
Mailing Address - Phone:480-893-9027
Mailing Address - Fax:480-893-9173
Practice Address - Street 1:1445 W ELLIOT RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1103
Practice Address - Country:US
Practice Address - Phone:480-893-9027
Practice Address - Fax:480-893-9173
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist