Healthcare Provider Details

I. General information

NPI: 1447985593
Provider Name (Legal Business Name): JENESSA LYNNE MELNINKAITIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENESSA LYNNE TETA

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SCOVILL ST FL 2
WATERBURY CT
06706-1134
US

IV. Provider business mailing address

95 SCOVILL ST FL 2
WATERBURY CT
06706-1134
US

V. Phone/Fax

Practice location:
  • Phone: 203-465-5292
  • Fax: 203-465-5296
Mailing address:
  • Phone: 203-465-5292
  • Fax: 203-465-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPCT.0015987
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: