Provider Demographics
NPI:1144184631
Name:LEE, CASSIDY MEGAN
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MEGAN
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4618
Mailing Address - Country:US
Mailing Address - Phone:918-748-8350
Mailing Address - Fax:918-747-1974
Practice Address - Street 1:2429 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4618
Practice Address - Country:US
Practice Address - Phone:918-748-8350
Practice Address - Fax:918-747-1974
Is Sole Proprietor?:No
Enumeration Date:2025-12-10
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist