Healthcare Provider Details

I. General information

NPI: 1942802715
Provider Name (Legal Business Name): MELISSA KOBLITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 WINDWARD PLZ
ALPHARETTA GA
30005-7449
US

IV. Provider business mailing address

6382 LUCENT LN
ATLANTA GA
30328-2893
US

V. Phone/Fax

Practice location:
  • Phone: 770-475-3628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH016225
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: