Provider Demographics
NPI:1467540633
Name:LE, KELVIN MINH (PHARMD)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:MINH
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 PASEO DEL RIO NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-1469
Mailing Address - Country:US
Mailing Address - Phone:727-578-0729
Mailing Address - Fax:
Practice Address - Street 1:1043 PASEO DEL RIO NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-1469
Practice Address - Country:US
Practice Address - Phone:727-578-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist