=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851604094
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEE JAMES EUSTON RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2010
-----------------------------------------------------
Last Update Date | 07/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1808 SALEM RID
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-471-1053
-----------------------------------------------------
Fax | 757-471-3309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5021 THATCHER WAY
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23456-6360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-471-7152
-----------------------------------------------------
Fax | 757-471-3309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 00006470
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP031157L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------