Healthcare Provider Details

I. General information

NPI: 1245249465
Provider Name (Legal Business Name): MELVILLE A. BADWAY R.PH., CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7870 ARBOR CREST WAY
PALM BEACH GARDENS FL
33412-2467
US

IV. Provider business mailing address

7870 ARBOR CREST WAY
PALM BEACH GARDENS FL
33412-2467
US

V. Phone/Fax

Practice location:
  • Phone: 610-905-4038
  • Fax:
Mailing address:
  • Phone: 610-905-4038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01779500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP042215R
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS45516
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: