Healthcare Provider Details

I. General information

NPI: 1982913158
Provider Name (Legal Business Name): MR. LEE J TEMPLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 JEFFERSON ST STE B
MARIANNA FL
32446-2318
US

IV. Provider business mailing address

2886 MAGNOLIA BLOSSOM LN
MARIANNA FL
32446-6394
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-2839
  • Fax:
Mailing address:
  • Phone: 850-482-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS0033694
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: