Provider Demographics
NPI:1184600546
Name:LEE, ROBERT WAYNE (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WAYNE
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 AUTUMNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-4565
Mailing Address - Country:US
Mailing Address - Phone:817-441-1156
Mailing Address - Fax:817-782-6120
Practice Address - Street 1:1711 DOOLITTLE AVE
Practice Address - Street 2:NAVAL AIR STATION
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76127-1133
Practice Address - Country:US
Practice Address - Phone:817-782-5960
Practice Address - Fax:817-782-6120
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist