Provider Demographics
NPI:1851604094
Name:EUSTON, LEE JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:JAMES
Last Name:EUSTON
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 1:5021 THATCHER WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6360
Mailing Address - Country:US
Mailing Address - Phone:757-471-7152
Mailing Address - Fax:757-471-3309
Practice Address - Street 1:1808 SALEM RID
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456
Practice Address - Country:US
Practice Address - Phone:757-471-1053
Practice Address - Fax:757-471-3309
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI00006470183500000X
PARP031157L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist