Healthcare Provider Details

I. General information

NPI: 1710964358
Provider Name (Legal Business Name): SHLEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 DALE ST
KINGSPORT TN
37660
US

IV. Provider business mailing address

1046 DALE ST
KINGSPORT TN
37660
US

V. Phone/Fax

Practice location:
  • Phone: 423-246-9242
  • Fax: 423-246-9242
Mailing address:
  • Phone: 423-246-9242
  • Fax: 423-246-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number405
License Number StateTN

VIII. Authorized Official

Name: RONALD W LEE
Title or Position: OWNER
Credential: PD
Phone: 423-246-9242