Provider Demographics
NPI:1265732754
Name:FLETCHER, ELWOOD LEE JR
Entity type:Individual
Prefix:MR
First Name:ELWOOD
Middle Name:LEE
Last Name:FLETCHER
Suffix:JR
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 1:540 BENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2542
Mailing Address - Country:US
Mailing Address - Phone:410-384-1633
Mailing Address - Fax:410-384-1636
Practice Address - Street 1:540 BENFIELD RD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2542
Practice Address - Country:US
Practice Address - Phone:410-384-1633
Practice Address - Fax:410-384-1636
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist