Provider Demographics
NPI:1679052989
Name:LEE, SHOUA N (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHOUA
Middle Name:N
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 1:6719 E 85TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7006
Mailing Address - Country:US
Mailing Address - Phone:209-605-3998
Mailing Address - Fax:
Practice Address - Street 1:4404 S PEORIA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3926
Practice Address - Country:US
Practice Address - Phone:918-749-1607
Practice Address - Fax:918-749-1642
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist