Provider Demographics
NPI:1093358855
Name:HOCHMUTH, LEE ALEXANDER (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ALEXANDER
Last Name:HOCHMUTH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11804 13TH WAY N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1501
Mailing Address - Country:US
Mailing Address - Phone:386-365-0661
Mailing Address - Fax:
Practice Address - Street 1:1505 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2552
Practice Address - Country:US
Practice Address - Phone:479-640-7347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS47785OtherPHARMACIST LICENSE