Basic Information
| Provider Information | |||||||||
| NPI: | 1265962153 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEE'S SUPER DRUG | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W CHOCTAW ST | ||||||||
| Address2: | |||||||||
| City: | DUMAS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716392005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703824007 | ||||||||
| FaxNumber: | 8703824008 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 W CHOCTAW ST | ||||||||
| Address2: | |||||||||
| City: | DUMAS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716392005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703824007 | ||||||||
| FaxNumber: | 8703824008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LEE JR | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8703824007 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARMACIST | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.