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General NPI Number Information
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NPI Number | 1093675852
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Entity Type | Individual
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Provider Name | NICHOLAS LEE
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Gender | Male
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/23/2025
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Provider Practice Location Address
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Address Line | 1801 N 18TH ST STE 1
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City | MONROE
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State | LA
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Zip | 71201-4401
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Country | US
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Telephone | 318-340-6470
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Fax |
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Provider Business Mailing Address
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Address Line | 4207 OWL ST
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City | MONROE
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State | LA
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Zip | 71203-5422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 026000
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License Number State | LA
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