Provider Demographics
NPI:1518674662
Name:BLEVINS, MICHELLE GENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GENEE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BLEVINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7534 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2533
Mailing Address - Country:US
Mailing Address - Phone:561-964-1363
Mailing Address - Fax:
Practice Address - Street 1:7534 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2533
Practice Address - Country:US
Practice Address - Phone:561-963-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist