Healthcare Provider Details

I. General information

NPI: 1245390400
Provider Name (Legal Business Name): LEE'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ARLINGTON ST
ADA OK
74820-4072
US

IV. Provider business mailing address

1201 ARLINGTON ST
ADA OK
74820-4072
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-4455
  • Fax: 580-332-4738
Mailing address:
  • Phone: 580-332-4455
  • Fax: 580-332-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number233836
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. LEE ALLEN ROSS
Title or Position: PHARMACIST
Credential: DPH
Phone: 580-332-4455