Provider Demographics
NPI:1295861565
Name:LEE, RICHARD C (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
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 1:930 VESTAVIA DR SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-2202
Mailing Address - Country:US
Mailing Address - Phone:256-353-4742
Mailing Address - Fax:
Practice Address - Street 1:930 VESTAVIA DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-2202
Practice Address - Country:US
Practice Address - Phone:256-353-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist