MEDICARE: MICHELLE GENEE BLEVINS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS40595	FL

General Provider Information

NPI Number	:	1518674662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE GENEE BLEVINS PHARMD

Provider Business Mailing Address
First Line	:	7534 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2533
Country	:	US
Telephone Number	:	561-964-1363
Fax Number	:

Provider Business Practice Location Address
First Line	:	7534 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2533
Country	:	US
Telephone Number	:	561-963-3391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2022
Last Update Date	:	10/28/2022

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