Provider Demographics
NPI:1265042030
Name:LEE, AMBER NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
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 1:3712 POSTON RD
Mailing Address - Street 2:
Mailing Address - City:COWARD
Mailing Address - State:SC
Mailing Address - Zip Code:29530-5374
Mailing Address - Country:US
Mailing Address - Phone:843-373-9557
Mailing Address - Fax:
Practice Address - Street 1:733 S IRBY ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5213
Practice Address - Country:US
Practice Address - Phone:843-665-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK164566183500000X
SC42616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist