Provider Demographics
NPI:1568502177
Name:STEWART, LEE ELLIOTT
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:ELLIOTT
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LEE
Other - Middle Name:ELLIOTT
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:4427 CHAIRES CROSS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7639
Mailing Address - Country:US
Mailing Address - Phone:850-878-6324
Mailing Address - Fax:
Practice Address - Street 1:1350 E TENNESSEE ST
Practice Address - Street 2:C-2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5179
Practice Address - Country:US
Practice Address - Phone:850-216-1021
Practice Address - Fax:850-216-1042
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist