Elvis Lettsome
Individual provider Active NPI Pharmacist · Wellborn, FL
NPI 1619616455 · NPPES record last updated May 31, 2022
Key facts
- NPI
- 1619616455
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS33020 (FL)
- Practice address
- 4500 Central Rd
Wellborn, FL 32094-3460 - Phone
- (305) 487-2882
- NPI assigned
- May 31, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS33020 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS33020 | FL | Yes |
Addresses
Primary practice location
4500 Central Rd
Wellborn, FL 32094-3460
Mailing address
4500 Central Rd
Wellborn, FL 32094-3460
Other providers in Wellborn, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.