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NPI Code Detail

MEDICARE: MR. LEE SCOTT RENFRO D.PH.

MEDICARE: MR. LEE SCOTT RENFRO D.PH.
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
1183500000XPharmacist7144TN

General Provider Information

NPI Number : 1770667545
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LEE SCOTT RENFRO D.PH.
Provider Business Mailing Address
First Line : 15 S HILLS CIR
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-9211
Country : US
Telephone Number : 423-929-2481
Fax Number :
Provider Business Practice Location Address
First Line : 1619 W MARKET ST
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6018
Country : US
Telephone Number : 423-926-9137
Fax Number : 423-926-7321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/08/2007

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