Basic Information
| Provider Information | |||||||||
| NPI: | 1225166549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAIN | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | JOHNSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430319197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409670404 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 244 NORTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7408922971 | ||||||||
| FaxNumber: | 7408923075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 24246-03 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.