Provider Demographics
NPI:1902180623
Name:LEE, SUSAN H (RPH)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2546
Mailing Address - Country:US
Mailing Address - Phone:636-949-6613
Mailing Address - Fax:636-949-6945
Practice Address - Street 1:2329 W CLAY ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2546
Practice Address - Country:US
Practice Address - Phone:636-949-6613
Practice Address - Fax:636-949-6945
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist