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NPI Code Detail

MEDICARE: EDWARD LEE JUSTICE III

MEDICARE: EDWARD LEE JUSTICE III
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
1183500000XPharmacist9097AL

General Provider Information

NPI Number : 1780952317
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD LEE JUSTICE III
Provider Business Mailing Address
First Line : 9665 BELLA DR
Second Line :
City : DAPHNE
State : AL
Zip : 36526-6271
Country : US
Telephone Number : 251-928-7762
Fax Number :
Provider Business Practice Location Address
First Line : 30957 MILL LN
Second Line :
City : SPANISH FORT
State : AL
Zip : 36527-5453
Country : US
Telephone Number : 251-625-4654
Fax Number : 251-625-4774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2011
Last Update Date : 12/10/2011

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