Healthcare Provider Details

I. General information

NPI: 1609975648
Provider Name (Legal Business Name): MELISSA BAILEY DE REYNA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN BAILEY PHARM D

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 W LAKE MARY BLVD
LAKE MARY FL
32746-3349
US

IV. Provider business mailing address

216 JUNIPER RIDGE CT
SANFORD FL
32771-7492
US

V. Phone/Fax

Practice location:
  • Phone: 407-549-3115
  • Fax:
Mailing address:
  • Phone: 504-400-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT-010333
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16621
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS63686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: