Provider Demographics
NPI:1497028963
Name:MAXWELL, MELVIN LEE (RPH)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:LEE
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-5639
Mailing Address - Country:US
Mailing Address - Phone:850-572-6008
Mailing Address - Fax:
Practice Address - Street 1:306 S 61ST AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-5639
Practice Address - Country:US
Practice Address - Phone:850-572-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19781183500000X
AL13756183500000X
MSE-06118183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist