MEDICARE: LEE DRUG STORE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	106040	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0103008	OTHER	AL	NACDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568480507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE DRUG STORE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 929
Second Line	:	18530 FLORIDA ST
City	:	ROBERTSDALE
State	:	AL
Zip	:	36567-0929
Country	:	US
Telephone Number	:	251-947-7378
Fax Number	:	251-947-7394

Provider Business Practice Location Address
First Line	:	18530 FLORIDA STREET
Second Line	:
City	:	ROBERTSDALE
State	:	AL
Zip	:	36567
Country	:	US
Telephone Number	:	251-947-7378
Fax Number	:	251-947-7394

Authorized Official
Title or Position	:	PRESIDENT/TREASURER - LEE DRUG STOR
Name	:	MRS. DONNA RAWLS BROWN
Credential	:	B.S., MSC, AL PHARM
Telephone Number	:	251-947-7378

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	06/29/2011

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Directions to “LEE DRUG STORE, INC. ” Practice Location

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