Provider Demographics
NPI:1922608900
Name:LEE, JEFFREY C
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 W SKYVIEW CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-6192
Mailing Address - Country:US
Mailing Address - Phone:352-270-9500
Mailing Address - Fax:
Practice Address - Street 1:1936 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9680
Practice Address - Country:US
Practice Address - Phone:352-228-6003
Practice Address - Fax:352-228-6004
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist