Provider Demographics
NPI:1811975766
Name:RICHARDS-LEE, JEWEL SHARON CAMILLE (RPH)
Entity type:Individual
Prefix:MRS
First Name:JEWEL
Middle Name:SHARON CAMILLE
Last Name:RICHARDS-LEE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WOODSTORK WAY
Mailing Address - Street 2:
Mailing Address - City:FROSTPROOF
Mailing Address - State:FL
Mailing Address - Zip Code:33843-9553
Mailing Address - Country:US
Mailing Address - Phone:863-635-4272
Mailing Address - Fax:863-635-4272
Practice Address - Street 1:586 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9508
Practice Address - Country:US
Practice Address - Phone:863-699-2182
Practice Address - Fax:863-659-4176
Is Sole Proprietor?:No
Enumeration Date:2006-01-01
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102831600Medicaid