Provider Demographics
NPI:1396247771
Name:BLEVINS, LESTER STEVE
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:STEVE
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 HIGHWAY 31 W
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-4754
Mailing Address - Country:US
Mailing Address - Phone:615-323-7349
Mailing Address - Fax:615-325-7038
Practice Address - Street 1:100 W KNIGHT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TN
Practice Address - Zip Code:37148-1415
Practice Address - Country:US
Practice Address - Phone:615-325-9218
Practice Address - Fax:615-325-7038
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4341183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist