Provider Demographics
NPI:1831326271
Name:STULL, LEE ANISSA (RPH)
Entity type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANISSA
Last Name:STULL
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 1:2424 ADDMORE LN LOT 42
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-9172
Mailing Address - Country:US
Mailing Address - Phone:502-548-7199
Mailing Address - Fax:
Practice Address - Street 1:1106 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2370
Practice Address - Country:US
Practice Address - Phone:812-285-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018288A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist