Provider Demographics
NPI:1245485747
Name:LEE, ROBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
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 1:6400 OAKES RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2639
Mailing Address - Country:US
Mailing Address - Phone:503-332-5454
Mailing Address - Fax:216-635-4500
Practice Address - Street 1:5500 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44131-1834
Practice Address - Country:US
Practice Address - Phone:216-524-5003
Practice Address - Fax:216-635-4500
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist