Provider Demographics
NPI:1902022205
Name:LEE, CHRISTINE CRUZ (CPHT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CRUZ
Last Name:LEE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56449 REDMILL DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-1327
Mailing Address - Country:US
Mailing Address - Phone:985-290-6588
Mailing Address - Fax:
Practice Address - Street 1:56449 REDMILL DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-1327
Practice Address - Country:US
Practice Address - Phone:985-290-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3509183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician