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General NPI Number Information
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NPI Number | 1679052989
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Entity Type | Individual
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Provider Name | SHOUA N LEE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 4404 S PEORIA AVE
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City | TULSA
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State | OK
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Zip | 74105-3926
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Country | US
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Telephone | 918-749-1607
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Fax | 918-749-1642
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Provider Business Mailing Address
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Address Line | 6719 E 85TH ST N
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City | OWASSO
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State | OK
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Zip | 74055-7006
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Country | US
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Telephone | 209-605-3998
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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 | 16832
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License Number State | OK
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