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General NPI Number Information
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NPI Number | 1114513397
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Entity Type | Individual
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Provider Name | BENJAMIN LEE RPH
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Gender | Male
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Dates
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Enumeration Date | 12/12/2020
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Last Update Date | 12/12/2020
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Provider Practice Location Address
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Address Line | 10623 GIBSONTON DR
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City | RIVERVIEW
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State | FL
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Zip | 33578-5404
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Country | US
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Telephone | 813-677-4435
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 STAGECOACH TRL
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City | WIMAUMA
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State | FL
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Zip | 33598-7526
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Country | US
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Telephone | 313-580-2547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS40938
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License Number State | FL
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