Provider Demographics
NPI:1972634830
Name:LEE, KATHY J (RPH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:J
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 1:1712 US HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:CLARINDA
Mailing Address - State:IA
Mailing Address - Zip Code:51632-4069
Mailing Address - Country:US
Mailing Address - Phone:712-542-1401
Mailing Address - Fax:
Practice Address - Street 1:1800 N 16TH ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1165
Practice Address - Country:US
Practice Address - Phone:712-542-2161
Practice Address - Fax:712-542-6119
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist