Provider Demographics
NPI:1861795460
Name:PIERSON, LEE ANN
Entity type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:PIERSON
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 1:657 CORTE LOREN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-7318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6951 EL CAMINO REAL
Practice Address - Street 2:VONS PHARMACY
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009
Practice Address - Country:US
Practice Address - Phone:760-431-0437
Practice Address - Fax:760-929-6864
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist