Healthcare Provider Details

I. General information

NPI: 1851604094
Provider Name (Legal Business Name): LEE JAMES EUSTON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 SALEM RID
VIRGINIA BEACH VA
23456
US

IV. Provider business mailing address

5021 THATCHER WAY
VIRGINIA BEACH VA
23456-6360
US

V. Phone/Fax

Practice location:
  • Phone: 757-471-1053
  • Fax: 757-471-3309
Mailing address:
  • Phone: 757-471-7152
  • Fax: 757-471-3309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00006470
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP031157L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: