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General NPI Number Information
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NPI Number | 1336341254
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Entity Type | Individual
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Provider Name | JERRY WADE LEE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1950 ASPEN
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City | LUBBOCK
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State | TX
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Zip | 79403
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Country | US
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Telephone | 806-766-0268
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Fax | 806-767-1640
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Provider Business Mailing Address
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Address Line | 1602 10TH ST
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City | LUBBOCK
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State | TX
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Zip | 79401-2607
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Country | US
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Telephone | 806-766-0310
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Fax | 806-744-9580
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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 | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 36271
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License Number State | TX
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