Individual provider · NPI-1

Willie Mckelvin III

Pharmacy Technician · Port St Lucie, FL

NPI number1417837923
StatusActive
Last updated in NPPESSep 4, 2025

Details

NPI
1417837923
Entity type
Individual (NPI-1)
Name
Willie Mckelvin III
Sex
Male
Sole proprietor
No
Enumeration date
Sep 4, 2025
Certification date
Sep 4, 2025
Last updated
Sep 4, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
183700000X Pharmacy Technician129667FLYes

Practice location

1053 Sw Canary Ter
Port St Lucie, FL 34953-1818

Phone 561-449-4346

Mailing address

1053 Sw Canary Ter
Port St Lucie, FL 34953-1818

Phone 561-449-4346

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