Individual
KIMBERLY MAE MIRANDA MOLL LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
167 N MAIN ST, TUBA CITY, AZ 86045
(928) 283-2754
(928) 283-2758
Mailing address
710 THREE CHIMNEYS WAY, OAKDALE, CA 95361-7781
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
CA
Other
Enumeration date
03/04/2022
Last updated
06/06/2022
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