Provider Demographics
NPI:1790109858
Name:OVERSTREET, LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:OVERSTREET
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-1652
Mailing Address - Country:US
Mailing Address - Phone:812-949-5015
Mailing Address - Fax:812-949-7363
Practice Address - Street 1:1702 E SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-1652
Practice Address - Country:US
Practice Address - Phone:812-949-5015
Practice Address - Fax:812-949-7363
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024948A183500000X
WY2713183500000X
KY011954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist