Provider Demographics
NPI:1396066304
Name:LEE, DOROTHEA DIAN (RPH)
Entity type:Individual
Prefix:MS
First Name:DOROTHEA
Middle Name:DIAN
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:PO BOX 93145
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1145
Mailing Address - Country:US
Mailing Address - Phone:817-583-6636
Mailing Address - Fax:
Practice Address - Street 1:2548 WINDCHASE DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2658
Practice Address - Country:US
Practice Address - Phone:214-797-1000
Practice Address - Fax:972-539-9276
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX371221835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric