Provider Demographics
NPI:1336330398
Name:LEE, NICOLE MAREE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MAREE
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 1:817 LEWIS HALL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65211-4330
Mailing Address - Country:US
Mailing Address - Phone:573-882-0568
Mailing Address - Fax:
Practice Address - Street 1:817 LEWIS HALL
Practice Address - Street 2:UNIVERSITY OF MISSOURI
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65211-4330
Practice Address - Country:US
Practice Address - Phone:573-882-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP6926183500000X
AZS015885183500000X
MO2008029237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist