MEDICARE: LEE WATSON RPH

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	PS29940	FL

General Provider Information

NPI Number	:	1780922088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE WATSON RPH

Provider Business Mailing Address
First Line	:	3777 PALM VALLEY RD
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-4115
Country	:	US
Telephone Number	:	904-273-6667
Fax Number	:	904-273-6575

Provider Business Practice Location Address
First Line	:	3777 PALM VALLEY RD
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-4115
Country	:	US
Telephone Number	:	904-273-6667
Fax Number	:	904-273-6575

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

Provider Enumeration Date	:	01/21/2013
Last Update Date	:	01/21/2013

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