Provider Demographics
NPI:1528382645
Name:LEE, MARK G (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 CENTURY CENTER PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-8822
Mailing Address - Country:US
Mailing Address - Phone:901-381-7400
Mailing Address - Fax:800-272-3887
Practice Address - Street 1:1620 CENTURY CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-0181
Practice Address - Country:US
Practice Address - Phone:901-381-7400
Practice Address - Fax:800-272-3887
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000009188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist