Provider Demographics
NPI:1689894982
Name:LEE, AGNES H (RPH)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 INTERSTATE 45 N STE 190
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2185
Mailing Address - Country:US
Mailing Address - Phone:310-346-9780
Mailing Address - Fax:
Practice Address - Street 1:61MDG-SGSAP 483 NORTH AVIATION BLVD
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2808
Practice Address - Country:US
Practice Address - Phone:310-653-6662
Practice Address - Fax:310-653-6658
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ121411835P1200X
TX68078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy