Provider Demographics
NPI:1235755166
Name:LEE, GEOFFREY ALAN
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:ALAN
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 N COUNTY ROAD 275 E
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-8069
Mailing Address - Country:US
Mailing Address - Phone:574-398-7319
Mailing Address - Fax:
Practice Address - Street 1:906 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-1740
Practice Address - Country:US
Practice Address - Phone:574-223-3249
Practice Address - Fax:574-223-4017
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013824A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy