Provider Demographics
NPI:1568056075
Name:GARCIA, LEE CAITLIN SAN PEDRO
Entity Type:Individual
Prefix:
First Name:LEE CAITLIN
Middle Name:SAN PEDRO
Last Name:GARCIA
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 1:6202 DOVERSIDE DR APT 188
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27523-6433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-1756
Practice Address - Country:US
Practice Address - Phone:252-640-6928
Practice Address - Fax:252-640-6933
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29169183500000X
NC29168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist