Healthcare Provider Details

I. General information

NPI: 1336330398
Provider Name (Legal Business Name): NICOLE MAREE LEE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 S MOUNT AUBURN RD
CAPE GIRARDEAU MO
63703-6387
US

IV. Provider business mailing address

711 S MOUNT AUBURN RD
CAPE GIRARDEAU MO
63703-6387
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-4151
  • Fax:
Mailing address:
  • Phone: 735-686-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS015885
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2008029237
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2008029237
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: