MEDICARE: LESTER STEVE BLEVINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	4341	TN

General Provider Information

NPI Number	:	1396247771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESTER STEVE BLEVINS

Provider Business Mailing Address
First Line	:	5250 HIGHWAY 31 W
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-4754
Country	:	US
Telephone Number	:	615-323-7349
Fax Number	:	615-325-7038

Provider Business Practice Location Address
First Line	:	100 W KNIGHT ST
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-1415
Country	:	US
Telephone Number	:	615-325-9218
Fax Number	:	615-325-7038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	03/01/2018

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Directions to “ LESTER STEVE BLEVINS ” Practice Location

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