Provider Demographics
NPI:1174842900
Name:LETT, WILLIE F
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:F
Last Name:LETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 COUNTY ROAD 158
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-7939
Mailing Address - Country:US
Mailing Address - Phone:281-756-0835
Mailing Address - Fax:
Practice Address - Street 1:1515 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5801
Practice Address - Country:US
Practice Address - Phone:281-996-1241
Practice Address - Fax:281-756-1248
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist