Provider Demographics
NPI:1194828475
Name:BRICE, LEE ALLAN (RPH)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ALLAN
Last Name:BRICE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5307 POND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-3417
Mailing Address - Country:US
Mailing Address - Phone:904-268-1972
Mailing Address - Fax:
Practice Address - Street 1:5909 UNIVERSITY BLVD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4911
Practice Address - Country:US
Practice Address - Phone:904-636-0500
Practice Address - Fax:904-636-5777
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0015581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist