Provider Demographics
NPI:1851433858
Name:LEE COUNTY COOPERATIVE CLINIC
Entity Type:Organization
Organization Name:LEE COUNTY COOPERATIVE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:870-298-4230
Mailing Address - Street 1:530 ATKINS BLVD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2113
Mailing Address - Country:US
Mailing Address - Phone:870-295-5225
Mailing Address - Fax:870-295-6900
Practice Address - Street 1:530 ATKINS BLVD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:AR
Practice Address - Zip Code:72360-2113
Practice Address - Country:US
Practice Address - Phone:870-295-5225
Practice Address - Fax:870-295-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy