Provider Demographics
NPI:1629898127
Name:KOHLER, LEE DAVID
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:DAVID
Last Name:KOHLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PEVELY
Mailing Address - State:MO
Mailing Address - Zip Code:63070-1529
Mailing Address - Country:US
Mailing Address - Phone:636-479-6100
Mailing Address - Fax:636-479-6101
Practice Address - Street 1:7922 MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:AFFTON
Practice Address - State:MO
Practice Address - Zip Code:63123-2721
Practice Address - Country:US
Practice Address - Phone:314-638-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024040264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist