Healthcare Provider Details

I. General information

NPI: 1063659621
Provider Name (Legal Business Name): LEE ISLEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 8TH AVE
CRAMERTON NC
28032-1401
US

IV. Provider business mailing address

149 8TH AVE
CRAMERTON NC
28032-1401
US

V. Phone/Fax

Practice location:
  • Phone: 704-824-4401
  • Fax: 704-824-7882
Mailing address:
  • Phone: 704-824-4401
  • Fax: 704-824-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18237
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: