Provider Demographics
NPI:1699567321
Name:THERVIL, WILLINEZA (PHARMD)
Entity type:Individual
Prefix:
First Name:WILLINEZA
Middle Name:
Last Name:THERVIL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6241 OLIVEDALE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3822
Mailing Address - Country:US
Mailing Address - Phone:954-939-4522
Mailing Address - Fax:
Practice Address - Street 1:110 BULLARD PKWY
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5510
Practice Address - Country:US
Practice Address - Phone:813-988-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS68195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist