Provider Demographics
NPI:1780922088
Name:WATSON, LEE (RPH)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:WATSON
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 1:3777 PALM VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4115
Mailing Address - Country:US
Mailing Address - Phone:904-273-6667
Mailing Address - Fax:904-273-6575
Practice Address - Street 1:3777 PALM VALLEY RD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-4115
Practice Address - Country:US
Practice Address - Phone:904-273-6667
Practice Address - Fax:904-273-6575
Is Sole Proprietor?:No
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist