Provider Demographics
NPI:1265962153
Name:LEE'S SUPER DRUG
Entity type:Organization
Organization Name:LEE'S SUPER DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE JR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:870-382-4007
Mailing Address - Street 1:105 W CHOCTAW ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-2005
Mailing Address - Country:US
Mailing Address - Phone:870-382-4007
Mailing Address - Fax:870-382-4008
Practice Address - Street 1:105 W CHOCTAW ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-2005
Practice Address - Country:US
Practice Address - Phone:870-382-4007
Practice Address - Fax:870-382-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy