Provider Demographics
NPI:1245577212
Name:LEE, CHARLES CLIFTON (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:CLIFTON
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 HARDMAN LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3103
Mailing Address - Country:US
Mailing Address - Phone:770-928-1182
Mailing Address - Fax:
Practice Address - Street 1:1824 HARDMAN LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3103
Practice Address - Country:US
Practice Address - Phone:770-928-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist