Healthcare Provider Details

I. General information

NPI: 1407471022
Provider Name (Legal Business Name): MELISSA MAUREEN DIAMOND PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3478 ROLLING ACRES RD
PACE FL
32571-9307
US

IV. Provider business mailing address

3478 ROLLING ACRES RD
PACE FL
32571-9307
US

V. Phone/Fax

Practice location:
  • Phone: 850-384-5162
  • Fax:
Mailing address:
  • Phone: 850-384-5162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16603
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: