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General NPI Number Information
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NPI Number | 1942846696
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Entity Type | Individual
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Provider Name | DAVID JASON LEE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 1207 S BAILEY ST
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City | ELECTRA
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State | TX
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Zip | 76360-3221
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Country | US
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Telephone | 940-495-5205
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1112
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City | ELECTRA
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State | TX
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Zip | 76360-1112
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Country | US
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Telephone | 940-495-5205
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 41708
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License Number State | TX
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