Provider Demographics
NPI:1902408552
Name:DORSEY-LEE, MARY ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ROBERT
Last Name:DORSEY-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 1:635 POTOMAC STATION DR NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1818
Mailing Address - Country:US
Mailing Address - Phone:571-258-1901
Mailing Address - Fax:844-411-6280
Practice Address - Street 1:635 POTOMAC STATION DR NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1818
Practice Address - Country:US
Practice Address - Phone:571-258-1901
Practice Address - Fax:571-258-1909
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist