Provider Demographics
NPI:1023029014
Name:LEES, DERIL J SR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DERIL
Middle Name:J
Last Name:LEES
Suffix:SR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3601
Mailing Address - Country:US
Mailing Address - Phone:918-665-2003
Mailing Address - Fax:918-665-8283
Practice Address - Street 1:3707 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3601
Practice Address - Country:US
Practice Address - Phone:918-665-2003
Practice Address - Fax:918-665-8283
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist