Provider Demographics
NPI:1275130874
Name:LEE, EDMOND MACK (RPH)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:MACK
Last Name:LEE
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 1:104 SWEETHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-7198
Mailing Address - Country:US
Mailing Address - Phone:615-585-2644
Mailing Address - Fax:
Practice Address - Street 1:3600 MALLORY LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2900
Practice Address - Country:US
Practice Address - Phone:615-771-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5507183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist