Provider Demographics
NPI:1528338118
Name:CLINE, TOMMY LEE
Entity type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:LEE
Last Name:CLINE
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 1:520 NE 20TH ST
Mailing Address - Street 2:APT. 510
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2105
Mailing Address - Country:US
Mailing Address - Phone:954-895-4029
Mailing Address - Fax:
Practice Address - Street 1:520 NE 20TH ST
Practice Address - Street 2:APT. 510
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-2105
Practice Address - Country:US
Practice Address - Phone:954-895-4029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist