Provider Demographics
NPI:1336464379
Name:LEE, MYRA MILLER
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:MILLER
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-2825
Mailing Address - Country:US
Mailing Address - Phone:205-854-4320
Mailing Address - Fax:
Practice Address - Street 1:1400 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-2825
Practice Address - Country:US
Practice Address - Phone:205-854-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist