Provider Demographics
NPI:1679867568
Name:LEE, REBECCA L (PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
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 1:6119 STELLHORN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-5357
Mailing Address - Country:US
Mailing Address - Phone:260-485-4697
Mailing Address - Fax:260-485-4697
Practice Address - Street 1:6119 STELLHORN RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-5357
Practice Address - Country:US
Practice Address - Phone:260-485-4697
Practice Address - Fax:260-485-4697
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018980A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist