Provider Demographics
NPI:1760525240
Name:LEES FAMILY PHARMACY LLC
Entity Type:Organization
Organization Name:LEES FAMILY PHARMACY LLC
Other - Org Name:LEE'S FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEDMAN
Authorized Official - Middle Name:JERMAINE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-696-8330
Mailing Address - Street 1:1218 FAIRBURN RD SW STE 103
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2172
Mailing Address - Country:US
Mailing Address - Phone:404-696-8330
Mailing Address - Fax:404-696-1759
Practice Address - Street 1:1218 FAIRBURN RD SW STE 103
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2172
Practice Address - Country:US
Practice Address - Phone:404-696-8330
Practice Address - Fax:404-696-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336C0003X
GAPHRE0065833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003114157AMedicaid
2015197OtherPK